Zap the Gap - Water

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Zap the Gap - Water

This form is to assist the Mississippi Public Service Commission identify gaps in water service across our state.

Email *

Prefix

First Name *

Last Name *

Suffix

Address 1 (Physical Address) *

Address 2 (Physical Address)

City *

State *

ZIP *

Address 1 (Mailing Address) *

Address 2 (Mailing Address)

City *

State *

ZIP *

County *

Primary Phone Number *

Secondary Phone Number

Email Address (Please complete if you would like a confirmation email)

Do you currently have water to your home? *

Yes

If yes, who provides your service?

If you are planning new construction and need water service at that location, please provide the complete address below.

New Construction - Address 1

New Construction - Address 2

City

State

ZIP

Please provide any details that may be helpful in providing water service to your home.

Send me a copy of my responses.

Submit

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