Name of Apartment Complex:
Name of Rental Agency:
SERVICE REQUEST INFORMATION
Address for Service:
Apt. or Lot No.:
Last Known Occupant:
Date to be Turned On:
Date to be Turned Off:
1. Complete all information and fax signed application to the Customer Service Office at 318-242-7709.
2. Service requests must be received by 12:00pm for same day service. Requests received after this time will be
processed the next business day.
CUSTOMER SERVICE OFFICE USE ONLY
Apartment Complex or Rental Unit
Application for Service