Request for Utility Disconnect Form

Please fill out completely, all fields required


Name:
Utility Account Number:
Service Address:
Type of Disconnect:
Date of 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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Washington City Utah | (435) 656-6300
111 North 100 East | Washington, Utah 84780 [map]
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