Snowbird Stop/Start Service

4. Instructions
   Please fill out the form below if you would like to request snowbird status. Please give one business day notice for turn on/turn off request.

   Please fill out the form below if you would like to request snowbird status. Please give one business day notice for turn on/turn off request.

6. Customer # - Account Number #

   Located on Statement

8. First Name*

9. Last Name*

11. Service Address *

13. City
    Lafayette

    Lafayette

14. State
    Indiana

    Indiana

16. Main Contact Phone Number*

17. Alternate Phone Number

19. Date Requested:
    Date Requested:

    *Next Business Day

20. Requested Service*
    -- Select One --Turn Off WaterTurn On Water

22. Billing Address, If Different from Service Address

24. Billing Address Line 2

26. City

27. State

28. Zip

30. Additional Information:

    If you would like to request a specific time or leave any additional notes

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field