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Disconnect Utility Services

2. Request To Disconnect Utility Service(s)
   We will respond to your request within 1 - 2 business days. (Please keep in mind that our office is closed on weekends and Holidays.)
4. Utility Account Number*
5. Customer ID Number*
6. Date to End Service*
   Date to End Service
8. Customer - First Name*
   As shown on your driver's license
9. Customer - Last Name*
   As shown on your driver's license
10. Suffix
12. Physical Property (Service) Address (including any suite/apartment/space/unit numbers)*
14. I am responsible for the following Utility Service(s)

    1. Gas
    2. Water
    3. Solid Waste (Trash)
    4. Wastewater (Sewer)
15. Request to Email Final Bill

    1. I would like to receive my final bill via email
17. Forwarding - Mailing Address (including any suite/apartment/space/unit numbers)*
19. Forwarding - City*
20. Forwarding - State*
21. Forwarding - Zip*
23. Phone Number
24. Email Address*
26. Acknowledgement*

    1. I confirm that the information provided in this request is true and correct to the best of my knowledge.
27. 
28. Completed By:*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field