Critical Care Registration Form

The Easton Suburban Water Authority (ESWA) automatic dialing system is being updated for 2010. Our automatic dialing system allow ESWA to deliver automated phone calls, within minutes, to any group, large or small in case of a water emergency.

It is important to us to serve the water needs of all of our customers; however, some customers have special needs that require a continuous water supply for medical, environmental or other needs. In the event that supply is interrupted or there is a need to follow water precautions or restrictions, we may need to contact you immediately.

Please complete Section I of this form for emergency information purposes only. Section II of this form should be filled out only for general purposes.