E-Gov Services City of Selma

Utility Cuts

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Purpose. This form is used to communicate with city personnel to request services and information regarding utilities being cut.

* Information is required.

Contact Information

* First Name:
* Last Name:
Business Name:
* Email:
* Daytime Phone:	() –
Fax:	() –
Address:
City:
State:
ZIP:

Location of Requested Utility Cut

Please select the closest street number/streetname of location from list or select "*not on list". Provide any additional information on location in the box below.

* Address	- Or Other Not Listed - Invalid Address The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue. The address you entered
Unit:
	Provide any additional information on location in the box below.

Additional comments / questions:

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Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.