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2. 
4. Online submission is the preferred and fastest way to process your request.
6. Reason for Account Closure*

   1. Property Sold

   1. Moving/Relocating

   1. Other
8. Account Information
10. Account Name*
11. Account Number*
13. Identification
15. Driver's License, FEIN, or Other Valid ID No.: *
16. Requestor Name*
18. Upload Driver's License, FEIN, or Other Valid ID*
20. Service Address

22. Submission Schedule - Disconnection requests are accepted Monday through Friday, during regular business hours (8:00 AM to 5:00 PM ET), excluding holidays. Requests submitted after 12:00 PM (ET) will be processed on the next business day.
    Please Note: Requested disconnection dates cannot be in the past. Ensure the date selected allows sufficient time for processing within the stated schedule.

24. Service Address to be disconnected*
25. Requested Disconnection Date:*
27. Forwarding Address
29. Please note: The Post Office may not forward your final bill or refund. Be sure to update your mailing address.*
31. Contact Information
33. Email Address*
34. Telephone Number*
36. Acknowledgment

    I understand the City shall close my account and I am responsible for all charges up to the date this document is received by the City. Furthermore, I am aware, it can take up to one (1) billing cycle before the final bill and a refund check (if applicable) is mailed to the forwarding address.

38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature*
41. Last four digits of Account Holder Social Security Number*
43. Date*
    Date
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field