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Utility Billing Department Stop Service Request Form

2. 

6. Account Number*

7. Customer Name*

9. Service Address*

11. Final Request Date*

    Readings scheduled for a weekend will be processed on the next business day

12. Forwarding Address

14. Signature
    I hereby attest to the truth and exactness of all information supplied on and with this application. I also understand that the applicant or a representative must be present at the meeting in order for the board/commission to take action on the application.

    I hereby attest to the truth and exactness of all information supplied on and with this application. I also understand that the applicant or a representative must be present at the meeting in order for the board/commission to take action on the application.

16. Signature of Account Holder:*

17. Date:
    Date:

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

* indicates a required field