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New Construction Service Line Installation Request
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Step 2

*Indicates a required field.
*Builder Name
Business License ID #
*Mailing Address
*City *State *Zip/Postal Code
Billing Address (completed only if different than the mailing address)
City State Zip/Postal Code
*Phone (include area code) Fax
E-mail (if applicable)
*Service Address
*City *State *Zip/Postal Code
*Nearest Cross Street
*Is the service address inside city limits?
  Yes
  No
*Development Name
*Lot #  
 
Tax Parcel # (if known)  
 
Section, Township, Range (if known)
 
Requested Meter Location
Are there other locations to be served from this service line?
  Yes
  No
Square Footage of Premises
Service Line Length
Is an open trench provided?
  Yes
  No
If yes, when will the trench be open? Please provide number of business days.
  3 days
  7 days
  Will call
Is this service requested under a master agreement?
  Yes
  No
When is installation requested?
  1 week
  2 weeks
  3 weeks
*Appliances
*Number of Furnaces *Number of Water Heaters
*Number of Fireplaces *Number of Ranges
*Number of Dryers  
 
Other
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