| What is your request (Please select one) | 
|  | Order Water | 
| Order Water – At this C.F.S. rate (Required) | 
|  | 0 | 
| Order Water – Turn on date (Required) | 
|  | 04/20/2022 | 
| Order Water – Turn off date (Optional) | 
|  | 04/20/2022 | 
| Lateral Selection | 
|  | 15B | 
| Turnouts for Lateral 15B | 
|  | 42 | 
| Contact information | 
| Name | 
|  | Marlene – TEST | 
| Email | 
|  | info@gvwua.com | 
| Phone # | 
|  | (970) 640-6514 | 
| Remarks | 
|  | Hi Kyler. This is a test. |