New Address Request

For property address, structures and/or utility services.

NOTE: Required fields are indicated in red. They must be completed for the Address Request to be processed. If you do not have the required information, please obtain it before completing this Address Request.

* indicates a required field

Use Type: *

Additional Meter Request (For Code Enforcement)

Is this request for an additional meter on property zoned for Residential or Agricultural use?

NOTE: Additional Meter requests on residential or agricultural property require residential zoning approval by appropriate code enforcement agency. To obtain a "Request For Additional Meter" form, call 729-8628 or send an email to address.assignment@mlgw.org. Requesting customer must complete top portion of form and submit to appropriate code enforcement agency. Code enforcement will complete and forward directly to MLGW. Customer will be contacted upon receipt of the completed form.

Will this address be fed from existing service?

Will this address be separately metered?

Location Description

Is the lot in a subdivision? *

Site Plan

Attach surveyed site plan (DWG, TIF, PDF, SHP, GIF, JPG - DWG preferred)
Please email AutoCad site plans to Address.assignment@mlgw.org
We will process your request upon receipt of drawing file(s).

Person Requesting (Owner Representative)

Contact Name: *

Company: *

Contact Phone: *

Contact Cell Phone:

Contact Fax:

(e.g., 901-555-1234 or 9015551234)

Contact E-mail: *

Owner/Responsible Party for Property/Address

Owner Name: *

Contact Name (if different from owner):

Company Name (if applicable):

Address: *

City: *

State: *

ZIP: *

Contact Phone: *

Contact Cell Phone:

Contact E-mail:

Contact Fax:

Purpose of Address

Choose One: *

Indicate if any of the following apply:

Special Instructions: