RealtorTempServiceRF

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City of Valdosta

Realtor Temp Service Request Form

Realtor Name:

Realtor Contact:

Realtor Phone Number:

Realtor Address:

Realtor City:

Realtor State:

Realtor Zip:

Start Service:

Type of Service:

Service Address: (Include Apt #)

Service Zip:

Special Instructions:

I acknowledge that, as a condition of water service being established or restored, and in consideration of restoration or establishment of services, that it is my responsibility to inspect all indoor and outdoor plumbing fixtures and/or valves and to ensure that they are in the "OFF" position prior to establishment or restoration of service.