Order Form – Water Now

Status: July 7th, situation strained. Advance ordering reccommended.

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RUSH MY ORDER REQUEST + $50*

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You have checked the rush order option.

Requested Date of Delivery*

Your Address Information Below

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Are you out of water?*

Yes

Parish*

City of Hamliton – Street*

Devonshire – Street*

Hamilton Parish – Street*

Paget – Street*

Pembroke – Street*

Sandys – Street*

Smiths – Street*

Southampton – Street*

Town of St. Georges – Street*

St. Georges – Street*

Warwick – Street*

House Number*

House & Shutter Color, etc.*

Basic Directions*

Your Order Information

Number of Loads*

Caveat Emptor: beware 900 gallon trucks at seemingly lower prices. Our loads are 1,000+ gallons with a 5-10% overage; free.

Payment Type*

*Please note – during busy times electing not to pre-pay for your order may cause delay. If you choose a COD option, please monitor your phone as we will call ahead.

Credit Card*

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Notes for this date order *only* – e.g. “tank on front patio, not garage tank"

How did you hear about us?*

Other:*

Total

Save my information to make future orders a 45 second process?*

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Note: Username is your email address.

Name

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For Immediate Questions, call