Contact Information

 *

Contact Information

First Name	Last Name
Street Address 1	Street Address 2
Daytime Phone Numberext.	Cell Phone Numberext.
Email Address

Preferred Contact Method

Preferred Contact Method

Daytime Phone

Cell Phone

Email

Were you contacted by the Water Meter Division to schedule a meter replacement?

Were you contacted by the Water Meter Division to schedule a meter replacement?

Yes

No

First Preference -- Day

First Preference -- Day

Any day	Monday	Tuesday
Wednesday	Thursday	Friday

First Preference -- Time

First Preference -- Time

Any Hours	Any Morning Hours	Any Afternoon Hours
8:00 am - 9:00 am	9:00 am - 10:00 am	10:00 am - 11:00 am
11:00 am - 12:00 pm	1:15 PM - 2:15 PM	2:15 PM - 3:15 PM

Second Preference -- Day

Second Preference -- Day

Any day	Monday	Tuesday
Wednesday	Thursday	Friday

Second Preference -- Time

Second Preference -- Time

Any Hours	Any Morning Hours	Any Afternoon Hours
8:00 am - 9:00 am	9:00 am - 10:00 am	10:00 am - 11:00 am
11:00 am - 12:00 pm	1:15 pm - 2:15 pm	2:15 pm - 3:15 pm

Let us know if there is a specific DATE that works best for you and we will try to accommodate you. We will need to come inside during the appointment.

Let us know if there is a specific DATE that works best for you and we will try to accommodate you. We will need to come inside during the appointment.

Please provide any comments or special conditions we should be aware of, or any problems encountered while trying to use this form.

Please provide any comments or special conditions we should be aware of, or any problems encountered while trying to use this form.

The Ames Water Meter Division does not send unsolicited email nor do we provide email addresses to anyone outside of the City of Ames. Questions about how the information provided will be used can be addressed to Dave Blumer, Water Meter Supervisor.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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