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2. Service Address*
4. City
5. State
6. Zip Code
8. First Name*
9. Last Name*
11. Phone Number*
12. Moving In or Out*
    -- Select One --InOut
14. Water Meter Reading*

    Enter the NINE DIGIT reading from your water meter. 

15. 
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

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