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4. Instructions
   Please fill out this form to turn on/turn off irrigation service. Please give one business day's notice when scheduling.
6. Customer # - Account Number #
8. First Name*
9. Last Name*
11. Service Address *
13. City
    Lafayette
14. State
    Indiana
16. Primary Phone Number*
18. Service Date Requested?*
    Service Date Requested?
    *Next business day
19. Requested Service*
    -- Select One --Turn OnTurn Off
21. Additional Information:
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field