Service Line Self-Report Survey

We appreciate your assistance in gathering this pertinent information.

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* 1. Last Name, First Name (Must be utility account holder)

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* 2. Service Address

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* 3. Account Number (Optional)

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* 4. Phone Number

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* 5. Email Address

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* 6. Service Line Material

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* 7. Magnet Sticks to Pipe?

Yes

No

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* 8. Photo of Service Line (Highly Recommended)

Must submit photo to be eligible for prize drawing! Please take a photo of the service line that leads to your water meter.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.