Water Safe Application

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Personal Information

Full Name

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Phone

Property Information

Address

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City

State

Zip Code

Upload proof of ownership (deed, tax bill)

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Condition Assessment

Describe your plumbing/drainage issues

Upload last 2 years of tax returns

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Upload last 12 months of bank statements

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I certify that I am the legal homeowner and this property will not be sold within the next 10 years.

Commitment Declaration

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I accept the terms and conditions. *

By submitting this application, I certify that all information provided is true and accurate to the best of my knowledge.
I authorize Blessed Solutions US LLC to review my eligibility and share this information with partnering municipal or nonprofit agencies for funding consideration.

Personal Information

Property Information

Condition Assessment

Commitment Declaration

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