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2. Please complete this form to request a free WaterSmart Checkup. We will call you to schedule an appointment.
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Email Address
16. Preferred Time to Receive a Callback
    Preferred Time to Receive a Callback Start Time

    —

    Preferred Time to Receive a Callback End Time
18. Why you are requesting a Water-Smart check-up?

    Select all that apply:

    1. Concerned About Water Waste
    2. Find Ways to Save on Water Bill
    3. Other
    4. Suspect a Leak
20. Important information regarding the WaterSmart Checkup
    A person must be at the home or business at the time of the WaterSmart Checkup that can answer questions about customer water use and irrigation controller settings.
    
    Checkups typically last 1 hour. Appointment times are Tuesday to Friday 7:30 am to 2 pm.
    
    All water-using devices or appliances should be turned off during the checkup.
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field