Disconnects take place during normal weekly business hours.
This is a paper form that can be printed, completed and returned via fax or email instead of the electronic form submission. Return form to email@example.com
Please provide the address on the water bill where service should be discontinued.
(Non-Holiday Weekdays Only)
(Please give us the best phone number(s) to reach you with any questions or information.)
Please provide Name, Address, City + State + Zip where final refund/bill will be mailed.
We will email you a copy of this request.
By clicking the confirmation you agree to the date for the disconnect.
This field is not part of the form submission.
* indicates a required field