Action Center / Electric and/or Water Disconnection for Repairs / Washington, IN

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Electric and/or Water Disconnection for Repairs

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To request disconnection for repairs on a certain day, please fill out the form below.

* Denotes a required field

Name*

Phone Number

Phone Area Code-Phone 3-Phone 4 ext Extension

Email*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Description of Repairs Being Done:*

Name of Contractor/Person Doing Repairs:*

Date of Disconnection*

MonthDay Year,

Please Do Not Complete The Following Field

Date for Reconnection*

MonthDay Year,

Please click submit when finished

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