Priority Customer Self-Identification Form
Customers that require water to maintain business operations
Facility Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Primary Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Facility Type
*
Please Select
Car Wash
Gym/Fitness Center
Hair/Tanning Salon
Laundry
Multi-Unit Property
Public Pool
Any other customer that WSSC Water defines as a Priority Customer
Enter Facility Type
Additional Facilities
Kindly enter the number of additional facilities owned (if applicable)
Additional Comments
Submit
Should be Empty: