Information and Assistance Requests

If you need to request a referral for community service or for utilities verification, please complete this form and we will process it within 2-3 business days. 

Please make sure to include any contact information for sending the information to and let us know how we need to send the information.

Step 1 of 2

Customer Name(Required)
Customer Name or Authorized Business Representative
Service Address(Required)
What is the physical service address of your house or business where you receive service from the City of Eutaw?
Billing Address(Required)
What is the address you receive your mail from, or would you like to have your mail delivered to?

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