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Please complete the form to update the Priority Services Registration.

By completing this document, signing the declaration, and returning it to us you are confirming that you or the person you are registering on behalf of would like to be added to the Affinity Water Priority Services Register. You are also confirming that you are happy for Affinity Water to securely hold and process your contact information and information about the stated needs including limited medical informati

Fields marked with * are mandatory.

This contact information will be used to link your needs and our services. It will be held securely on our customer system and will be accessible to Affinity Water employees and trusted partners for providing you with clean, safe water.

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