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2. First Name*
4. Last Name*
6. Address*
8. Housing Addition*
10. Phone Number*
12. Utility Account Number*
14. Email Address*
16. By submitting this form, you are indicating that you wish to have your address added to the Collinsville No Knock List of addresses that door-to-door vendors may not visit.
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18. 1. Receive an email copy of this form.
19. Email address

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20. Submit

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