Request a Water Filter Pitcher

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Name *

Address *

Email Address *

Phone Number

How many people at this location will use the filter?

If more than 6, please explain:

Reason for requesting?*

Where did you hear about program?*

Currently, when you: drink water, make coffee/tea, prepare infant formula or cook; what is the source of your water?*

Has your home’s plumbing or water service line been updated since 1988?*

Optional Information

Additional Details or Comments

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Water and sewer leaks can also be reported by calling (504)52-WATER (529-2837)
24 Hours a Day. 7 Days a Week.