Form Center

2. LACONIA WATER DEPARTMENT EMERGENCY CONTACT FORM
4. The Laconia Water Department responds to numerous cases of frozen pipes and other emergencies. The sooner we can contact property owners, the better off they are. Please help us by filling out and submitting this form; this will allow us to update our records to reach you in an emergency. If you have any questions or require more information, please call us at 603-524-0901. We will not share your information with any outside organizations.
6. Name*
8. Property Address*
10. Home Phone Number*
12. Cell Phone Number*
14. Alternate Contact*
16. Email Address*
18. What is the best way to contact you?*
20. Thank you for your assistance!
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field