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2. Turn On / Off Service*

   1. On
   2. Off
4. Type of Service *

   1. Electric Only
   2. Electric & Water
   3. Water Only
6. Account Name *
8. Service Address (List all addresses that apply) **

   (List all addresses that apply).

10. Date Needed *
    Date Needed

    Date Needed
12. Mailing Address*
14. Requested By*
16. Best Contact Number*
18. Add This Service Address to Our Auto Turn on List

    1. Winter Only (November 1st - March 31st)
    2. Yearly
    3. Not Participating
20. Additional Comments
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

* indicates a required field