Self-Report Service Line Material

Self-Report Service Line Material

The intent of this form is for customers to report service line materials.
PW Account Number:*
000000-000
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
REPORT YOUR SERVICE LINE MATERIAL
USING ONE OR BOTH METHODS BELOW: *
Method 1: Locate and identify your service line.
Upload a photo of your service line here:

Cancelof
Service Line Material:

PlasticCopperCopper With SolderGalvanized IronLead
OR...
Method 2: Report your service line material based on first-hand knowledge.
Please select the Service Line Certification Statement:

I certify that I have categorized my service line material based on first-hand knowledge of its installation.
Service Line Material:

PlasticCopperCopper With SolderGalvanized IronLead
Should be Empty: