Action Center / Start Service / WCCD, Indiana

Please Do Not Complete The Following Field

Your New Information

First Name*

Last Name*

Subdivision

Lot Num.

Address*

City*

State*

Zip*

Zip-Zip +4
Second portion of ZIP Code is optional.

Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Email Address*

Owner or Renter*

I am the owner I am a renter

Change of Possession Date*

MonthDay Year,

Mailing/Billing Information

If the mailing address is different than the service address, please fill out the information below. If this will be a rental and you are the owner, you must list your mailing address for notices.

This property will be a rental

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

City

State

Zip Code

Zip-Zip +4
Second portion of ZIP Code is optional.

Start Service

Your New Information

Mailing/Billing Information

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