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Ascension Parish Residents Without Power
Please fill out this form in its entirety if you are without electricity at your home.
If/When your power is restored, please fill out this form again and check the "Power has been restored" check box.
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Today's Date
*
MM
/
DD
/
YYYY
First and Last Name
*
Your answer
Phone Number
*
Your answer
Email
Your answer
Street Number
*
Your answer
Street Name
*
Your answer
Zip Code
*
Your answer
Power Company Name
*
Entergy
Demco
Other:
Please let us know when power is restored by filling out this form again and checking the box below.
Power has been restored
Additional Comments
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