Form Center

2. Please fill out the application below and attach all necessary documents before submitting. You may choose a service connection date for the next business day or later. Please allow 1 to 2 business days to receive a response. 

   If you have not received a response, please contact our Customer Service Department at 318-673-5510.

4. Date*
   Date
5. Start New Service Date*
   Start New Service Date
7. Name*
8. Date of Birth*
9. Last 4 of Social Secuirty*
11. Service Address*
13. Type*

    1. Rent

    1. Own
15. Mailing Address*
17. City*
18. State*
19. Zip Code*
21. Home Phone Number*
23. Employer Name
24. Work Phone Number
26. Landlord Name
27. Landlord Phone
29. Signature*

    Please type in your full name.

30. Email Address
32. ID*

    Please attach a copy of your ID (i.e. driver's license).

33. Rental/Lease Agreement

    If you are renting the home/property please attach a copy of your rental agreement/lease.

35. Present at Property for Connection*

    I understand that if my water is off and needs to be turned on I must be at the property between 7:30 am and 2:30 pm.

    1. I agree.
37. Water Already On*

    I understand if the water is already on I do not have to be at the property for the connection.

    1. I agree.
Leave This Blank:


39. Submit

* indicates a required field