Online Forms

Start or Stop Utility Service

I am requesting

Note: If you are requesting new service, a deposit is required. Our Utilities Dept. will contact you by telephone to secure your deposit.

Name — First Name

Name — M.I.

Name — Last Name

Name — Suffix

Address where service is located — Street Number and Name

Address where service is located — Unit Number

Billing address for new service (Do not put old address) — Street Number and Name

Billing address for new service (Do not put old address) — Unit Number

Billing address for new service (Do not put old address) — City

Billing address for new service (Do not put old address) — State/Province/Region

Billing address for new service (Do not put old address) — Postal/ZIP Code

Please provide forwarding address if stopping service: — Street Number and Name

Please provide forwarding address if stopping service: — Unit Number

Please provide forwarding address if stopping service: — City

Please provide forwarding address if stopping service: — State/Province/Region

Please provide forwarding address if stopping service: — Postal/ZIP Code

Phone

Date of Service to Start or Stop

The City of Broussard follows the 1964 Civil Rights Act of Title VI

After completing this form and pressing submit, you will be redirected to online payment for your deposit. Your form will not be considered complete without this payment. Please be sure to follow through with payment instructions after pressing the submit button.

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