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

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Electric and/or Water Disconnection for Repairs

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

For additional information or questions on this form, contact Teena Roe.

* Denotes a required field

Please Do Not Complete The Following Field

Name

Phone Number

Phone Number Area Code-Phone Number Prefix-Phone Number Line Number ext Phone Number Extension

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,

Date for Reconnection

MonthDay Year,

Please click submit when finished

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