2. Request Water Shutoff at Curb Stop ~ $75 Fee
4. Date*
   Date

   Enter today's date

5. Services Request Date*
   Services Request Date

   Enter the date you request for this service

7. The date for this service must not include weekends or Federal Holidays. 

9. Name*

   Enter name of person to contact to setup time for Service Call.

10. Applicant is:*
    -- Select One --Owner/LandlordOccupant
12. Email Address*
14. Service Address*

    Enter the Address for which this service is being requested. This is also the address that will be billed the Service Call Fee.

15. Phone Number*

    Enter the Phone Number that matches the Applicant's Name.

17. NOTICE!

    The Curb Stop is property owners responsibility. Any damages or repairs needed to the Curb Stop are at the owners expense. The City of Pierre is not responsible for any damages or repairs needed as a result of the service call.

    The above listed customer requests a Service Call for the Shutoff of Water at the Curb Stop located at the Address in this Application. By submitting this request, the Customer understands and agrees to the $75 Service Call Fee. This fee will be billed to the Service Address in this Application with the next applicable Utility Bill. 

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

* indicates a required field