STEP 1: Request for Eligibility Form

2. Please continue to fill this form out if you are within the highlighted area below

   This request for eligibility will hold your spot on the list for the filter rebate program. This program is first come, first serve. If you are not within the highlighted area but have concerns of discolored water, please call DPW 978-897-1317

   
   

   *As of September 1, 2025, $200,000 has been exhausted. However we still encourage you to apply and get on the wait list. 

3. 
7. REQUEST FOR ELIGIBILITY
9. Name*
10. Address: number and street *
12. Phone Number*
13. Email Address*
15. You will need to receive communication throughout this process, please choose your preferred method of communication*

    1. Email
    2. Mail
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit Submit and Print

* indicates a required field