Forms

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Authorization Agreement for Automated Payments - must be accompanied by an original voided check.

Discontinue Service Request - must be received prior to the requested disconnect date. This form should include a forwarding address and may be emailed two business days prior to disconnect date to office2@lostcreekmud.org

New Customer Application - must be received with a deposit of $100.00 along with the Confidentiality Form and the LCNA Authorization Form prior to the service initiation date. Please call our office to verify a reconnect fee is not applicable.

updated: Tuesday, February 07, 2006