Department of Utilities, Water Division
Request for Service Form
(Other Than Real Estate Closing)
Date of request:
*
Account Number:
Owners name:
*
Service Address:
*
Plat/Lot:
*
Request for:
Readings( $35.00):
Seasonal turn on/off ($40.00):
Water shutdown for service(varies):
All others (with explanation):
[all fees will be charged in accordance with the current RIPUC Rate Tariffs]
E-mail address:
*
Company:
Phone #:
*
[for questions regarding this request]
Additional information:
[date needed, time requested etc]
* REQUIRED FIELDS
