Aqua Aid Donation Form

Aqua Aid is an assistance program that enables customers in need to receive uninterrupted service. The program is funded by donations from Aqua customers. Please fill out the form below to donate.

First Name

Last Name

Address

City

State

Zip Code

Enter a valid zip code.

Email Address

16 Digit Account Number

Enter your 16-digit account number using numbers only.

Donation Type

Monthly Donation Amount

Choose donation amount from the dropdown: $1, $3, $5 or other.

Donation Amount

Please enter the amount of a one-time donation, or a custom monthly donation.

I authorize Aqua to add this donation to my bill.

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