Form Center

2. PLEASE READ:

   To re-enroll in MASA, please fill out this form. 

   Following the completion of your form, the Town will process the form and enroll you with MASA. Please expect the charge to appear on your upcoming utility bill.

6. Resident Account Information

   All information provided must match the information the Town has on file for your account. This information can be found on your most recent utility bill. 

8. Full Name*
10. Address*
12. Account Number*
13. Customer Pin Number*
17. Contact Information
19. Email Address*
21. Phone Number*
25. Confirmation of Service Re-enrollment*

    By marking the check box below, I confirm that I am an authorized account holder for this account and that I am voluntarily choosing to re-enroll with MASA. I also understand that re-enrollment will lead to an additional charge on my utility bill for this service and that I should expect to see these charges on my upcoming utility bill and each month there-after. 

    1. Yes, I confirm that I agree to and understand the above statement.
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field