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2. External Utility Service
   The City of Whitehouse provides many services to those living in our community. While we do not provide gas, cable, internet, or electricity, we understand that our citizens may have trouble getting a response from some utility providers. In an effort to help resolve issues, we are providing this form so that we can capture the needed information to pass along to our contacts. Please note that in many cases, we have partners that are willing to help us resolve these issues, but our influence and ability to force a provider to resolve an issue is limited. This service is provided as a courtesy and we will always do what we can to help. In some cases, providers may not be able or willing to provide us specific account information.
4. First Name
5. Last Name
7. Phone Number
8. Fax Number
10. Email Address
12. Address
14. City
15. State
16. Zip Code
18. Utility Provider Name
20. Date Issue was Reported to Provider
    Date Issue was Reported to Provider
    Please give the provider a reasonable amount of time to resolve the issue.
21. Reference/Tracking/Confirmation Number
    Please provide any identifying information that we can use when communicating with the provider.
23. Description of Issue
    Please provide as much information as possible.
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field