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Service On/Off Request

Service start or stop request

Effective Date*
MM slash DD slash YYYY
Name*
Phone*
Email*
Service Address*
Requested By:*
- Owner
- Renter
Action Requested:*
- Turn Water On
- Turn Water Off
- Lock
Reason For Request:*
Forwarding Address - Required for Stop Service orders to mail final statement
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Hudson Water Works shall not be in any way responsible or liable for damages or losses due to water being turned on or turned off at the Customer's request. The Customer hereby holds Hudson Water Works harmless for any such losses due to damages to water heaters and other equipment due to discontinuance of water. The Customer agrees to pay for all metered water, even if such water is lost due to matters unrelated to use, including without limitation, hoses left on, sinks or tubs on, etc.
Signature*

Type your full name to digitally sign
Photo ID*
Accepted file types: jpg, gif, png, pdf, jpeg, doc, Max. file size: 512 MB.
Required: Attach a photo or scan of your valid State or Government issued ID for your account security
Additional Documents
Drop files here or

Max. file size: 512 MB, Max. files: 5.
Privacy*
- I consent to my submitted data being collected and stored