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Utility Disconnect Form

  1. Date you would like to disconnect service.
  2. Disconnect Time
    Time you would like the water to be disconnected.
  3. Submitting this form will cause your water to be disconnected on the date above. Your final bill will be mailed to the New Address you provide above. Any deposit you have on the account will be applied to your final bill and the remainder (if any) will be mailed to the New Address as well. Please save the print out of this form until you have received the final bill or deposit refund.
  4. Leave This Blank:

  5. This field is not part of the form submission.