Zap the Gap - Water
This form is to assist the Mississippi Public Service Commission identify gaps in water service across our state.
Email address *
Prefix
First Name *
Your answer
Last Name *
Your answer
Suffix
Address 1 (Physical Address) *
Your answer
Address 2 (Physical Address)
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
Address 1 (Mailing Address) *
Your answer
Address 2 (Mailing Address)
Your answer
City *
Your answer
State *
Your answer
ZIP *
Your answer
County *
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address (Please complete if you would like a confirmation email)
Your answer
Do you currently have water to your home? *
If yes, who provides your service?
Your answer
If you are planning new construction and need water service at that location, please provide the complete address below.
New Construction - Address 1
Your answer
New Construction - Address 2
Your answer
City
Your answer
State
Your answer
ZIP
Your answer
Please provide any details that may be helpful in providing water service to your home.
Your answer
Submit
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