SCCPA BWP Interest Form

Customer Name*
Business Name
Business Phone Number
Cell Phone Number
OK to Text

YesNo
Business Email
example@example.com
Business Address

Street Address

Unit/Suite

CityState / Province

Postal / Zip Code
City
Select Program of Interest*

Burbank Water & Power Business Bucks
How did you hear about us?*

City ReferralEmailFlyerPhone CallProperty ManagementOwnerOther

Best Time to Call

Comments
At least one of the following must be provided, so that we may contact you regarding the program(s) you have selected:
- Business Phone Number
- Cell Phone Number
- Business Email
Please provide one of these contact methods in order to submit this form.
Reply Email Address
Should be Empty: