Request for Utility Service Disconnect Request Form

Please fill out completely, all fields are required.
Please allow two (2) business days for requests to process. Requests received outside of business hours will begin processing the next business day.
Please do not submit requests more than 30 days in advance.
Name:
Utility Account Number:
Service Address:
Date for Disconnect:
Best Phone Number to Reach You:
Email Address:
Verify Email Address:
Forwarding Address:
Forwarding Zip Code:
*Please note: utilities are billed a month behind and a bill will be sent after meter has been read.

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