Account Setup Form

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    Shipping Information

    Account Name

    Contact Full Name

    Shipping Address

    Suite, Apt, Fl

    City, State and Zip

    Shipping Phone

    Shipping Email

    Billing Information

    Account Name

    Contact Full Name

    Billing Address

    Suite, Apt, Fl

    City, State and Zip

    Billing Phone

    Billing Email

    Credit Card Information

    Credit Card Type

    Full Name On Card

    Card CVV2#

    Credit Card Number

    Expiration Date

    YesNo To proceed you must check this box YES. By checking this box You fully understand and authorize us The Manhattan Water Company® to charge this card for any goods delivered or services rendered.

    General Information

    How did you hear about us:

    Please describe your order & delivery specifics:

    Once submitted your account will be set up in our systems, no credit cards will be charged or deliveries made till we contact you to activate your account.