What is your request
  Turn off water
Turn Off Water: Date for requested action Required
  04/20/2023
Turn Off Water – Meter Reading Required
  12344.56
Turn Off Water – Serial # Required
  123-45
Lateral Selection
  0DRN
Turnouts for Lateral 0DRN
  PMP
Contact information
Name
  test
Email
  test@gmail.com
Phone #
  (123) 456-7890
Remarks
  This is a test