Dade: (305) 759-5002
Fax: (305) 759-6103
Toll Free: (800) 276-5144
This form can be used when you do not have an established account.
NOTE: This form should not be used after hours. Please call direct at the phone numbers listed above.
Please fill out the form on the previous page
Serving South Florida for Over a Decade
"*" indicates required fields