Forms You May Need
Check out the following forms you may need as a new or current Aqua customer. If you need assistance, please reach out to Aqua Customer Service via the form on the Contact Us page.
Aqua Forms
Medical Certificate Form
A Medical Certificate is written confirmation from a customer’s physician or nurse practitioner that the customer, or someone else living at the property, has a medical condition that would be aggravated if Aqua shut off the water (usually for non-payment). Once received by Aqua, a valid medical certificate gives the customer 30 days to pay the bill or to make payment arrangements.
Send your medical certificate...
By mail:
ACO
Attention: Collections Department
762 W. Lancaster Avenue
Bryn Mawr, PA 19010
By fax: 866.780.8301
By email: nationalcollections@aquawater.com
Download Aqua's Medical Certificate here.
Download Aqua Ohio's Medical Certificate Form here.
Download Aqua Illinois' Medical Certificate Form here.
Aqua Leak Adjustment Forms
Illinois Residential Water, Sewer Service Form
Aqua Illinois Residential Water, Sewer Service Application Form
Download HereRevert to Landlord Permission Form
Revert to Landlord Permission Form
Download Here