Request for Disconnect of Services **NOTE: If you are needing to temporarily disconnect your irrigation meter for the season, fill out the Seasonal Irrigation Form instead. Otherwise, proceed with this form.** **If there are two people listed on your bill, please fill out this form using the FIRST name on the bill, which is the primary account holder. This includes their name, Social Security Number, and other information requested on the form.**Today's Date *Service Address *Customer Name (as appears on bill) *Requested Date of Disconnect *Disconnects can happen as early as 7:00 AM on the requested date of disconnect. We do not do same-day disconnects. We also do not do disconnects on Fridays. Applications should not be filled out more than two weeks ahead of your requested date of disconnect.You… *Own the propertyRent the propertyManage the propertyAre you selling the property? *YesNoClosing Date * Forwarding Address for Final BillForwarding Street Address *City *State *Zip Code * Driver's License Number *Last 4 Digits of Social Security Number or Tax ID *Phone Number *Email Address *By accepting below, the customer understands there will be a final bill sent to your forwarding address within approximately 30 days (+/-) after the date of disconnect, and the final bill will be due on the normal due date. The amount paid to have the water and/or sewer service connected originally was only a service fee and is non-refundable. *I accept these terms.Submit
