| 
		                                        What is your request (Please select one)
		                                     | 
 
|   | 
		                                        Order Water
		                                     | 
 
| 
		                                        Order water at this rate (C.F.S)
		                                     | 
 
|   | 
		                                        0
		                                     | 
 
| 
		                                        Order water turn on date
		                                     | 
 
|   | 
		                                        04/30/2022
		                                     | 
 
| 
		                                        Order water turn off date
		                                     | 
 
|   | 
		                                        04/28/2022
		                                     | 
 
| 
		                                        Lateral
		                                     | 
 
|   | 
		                                        36CA
		                                     | 
 
| 
		                                        Turnout for Laterals starting with 36
		                                     | 
 
|   | 
		                                        72
		                                     | 
 
| Contact information | 
 
| 
		                                        Name
		                                     | 
 
|   | 
		                                        test7
		                                     | 
 
| 
		                                        Email
		                                     | 
 
|   | 
		                                        test@gmail.com
		                                     | 
 
| 
		                                        Phone #
		                                     | 
 
|   | 
		                                        (123) 456-7890
		                                     | 
 
| 
		                                        Remarks
		                                     | 
 
|   | 
		                                        test 7
		                                     | 
 
 
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