What is your request
  Turn off water
Turn Off Water – Meter Reading Required
  123.45
Turn Off Water: Serial # Required
  12,345
Turn Off Water: Date for requested action Required
  04/27/2023
Lateral Selection
  0SP
Turnouts for Lateral 0SP
  1B
Contact information
Name
  test
Email
  test@gmail.com
Phone #
  (123) 456-7890
Remarks
  This is a test