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Contractor Service Form

Please complete the following information:
**Your request will be processed after request is verified by telephone .**

Note: * indicates required fields for submitting the request

Company Name*
Contact Person*
Mailing/Billing Address*
City*
State*
Zip*
Daytime Phone*
Email
 
When is the best time to contact you Monday - Friday between 8:00 am and 6:00 pm?
 
Communication Preference:
Phone
E-mail
 
Please list the address(es) of location(s) to have meters set:
Premise Number
Address
Turn on date
Premise Number
Address
Turn on Date
Premise Number
Address
Turn on Date
Premise Number
Address
Turn on Date
Premise Number
Address
Turn on Date
Premise Number
Address
Turn on Date
Premise Number
Address
Turn on Date
Start sending water bills to these addresses starting on turn on date?yes
no
 
Have you had service with us before?
yes
no
If so, where?
 
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