Horsham Water and Sewer Authority’sEmergency Notification System Powered by GeoDecisions “Notify” CONTACT INFORMATION FORM Please complete this form to add or make changes to the contact information associated with your Horsham Water and Sewer Authority account. Contact information is strictly confidential and is only used for Horsham Water & Sewer Authority business. Information obtained from this form shall not be used for billing collection purposes.. WATER/SEWER ACCOUNT NUMBER (required) (Include number(s) that show behind the dash) PROPERTY (SERVICE) ADDRESS (required) NAME OF PROPERTY OWNER(S) (required) ONE OR ALL PHONE NUMBER FIELDS MAY BE FILLED IN - PLEASE SPECIFY WHICH PHONE NUMBER SHOULD BE USED AS YOUR PRIMARY CONTACT HOME PHONE MOBILE PHONE WORK PHONE EMAIL Primary Selection (required) - Select -Home PhoneMobile PhoneWork Phone COMPLETED BY SIGNATURE Sign with your mouse, or your finger if on a mobile phone. ***PROPERTY OWNERS ARE RESPONSIBLE FOR ALL CUSTOMER ACCOUNT ACTIVITY – BILLS MAY BE MAILED TO TENANTS BUT PROPERTY OWNERS RETAIN ALL RESPONSIBILITY FOR PAYMENT*** TENANT NAME(S) HOME PHONE MOBILE PHONE WORK PHONE EMAIL Primary Selection - None -HomeMobileWork WEBSITE NOTICEOur website is a separate platform from our emergency call system. If you wish to receive announcements from the website you must sign up there as well. HWSA encourages everyone to sign up on our website, this is the quickest most effective way to receive emergency notifications. Completing this form authorizes Horsham Water and Sewer Authority to notify you for public notification at the methods selected above. Leave this field blank