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Hydrate Detroit Water Affordability Survey
This form is designed for collecting information about Water issues and concerns. If any Detroit residents have their water shutoff or need help with a high water bill. Hydrate Detroit requires residents to fill out this Water Intake Form

In order to qualify for assistance, you must meet the following Criteria

Must be a Detroit Resident (Homeowners with established water service)
Senior Citizens (Age 55 years or older)
Veterans or Persons with Disabilities or Health Issues
Single Families with Small Children

When you send the water intake form, A representative will be in touch with you when the information is received.

Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address *
Your answer
What is your preferred method of contact *
When is the best time to contact you *
DWSD Water Bill Customer Account Number *
Your answer
What is your current status *
Is Your Water Currently Shutoff Right Now *
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