Service Request Submission

Emergency Service Protocol

Service Request

FOR EMERGENCY USE ONLY: Text the word “Emergency & your name & address” to 219-614-3423 with the nature of your emergency. Please submit your request online as well. During business hours you may also call 219-750-9247.

"*" indicates required fields

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Name*

Subdivision*

Email*

Re-Enter Email Address*

Preferred Contact Method*

Preferred Contact Time:*

Primary Phone*

Cell Phone*

Work Phone*

Service Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Category*

Nature of Emergency*

Please describe the issue in detail

Attach Photos and Images*

Accepted file types: jpg, png, tiff, bmp, svg, eps, Max. file size: 128 MB.