Full Payment. For customers enrolling by mail. Please
complete this form, print it, sign below, and mail it with
a $68 check or money order payable to Pennichuck Water. If
you pay by check/money order, your protection plan begins
within 10 days after your check/money order and enrollment
form have been received by Pennichuck, and your check has
been cleared by your bank.
Signature:_____________________________________________
Important Note: Your signature verifies enrollment,
and acceptance of the terms of the plan.
Mail
your form and payment to:
Pennichuck Water Service Corporation
PO Box 1947
25 Manchester Street
Merrimack, NH 03054
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*No Payment Now. For online or customers enrolling by mail.
Please bill me in four equal installment payments on
my monthly or quarterly water bills. I understand coverage
will not begin until the date of my next bill.
*By
clicking on the "submit" button below, you are verifying
your enrollment, and acceptance of the terms
of the plan. Please keep a copy of this form, and refer to
the WaterTight
Protection Plan page as your description of plan coverage.
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