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2. Date
   Date
3. Name*
5. Account Number
6. Property Address*
8. Date to have Service Discontinued*
   Date to have Service Discontinued

   Because water consumption is billed in arrears, you may receive a "regular bill" before receiving the "final bill".

9. Forwarding Address*
11. City*
12. State*
14. Zip*
15. Seasonal Termination (if applicable)?

    1. Yes
    2. No
17. Phone Number*
18. Email Address
20. Service Property

    1. Rent
    2. Own
21. If Owner, did you sell the Property?

    1. Yes
    2. No
23. New Owner's Name

    I understand as a property owner that I am subject to the monthly garbage and stormwater fee charge until the property is sold or a tenant establishes a utility account with the City.

    Please remember that issued trash carts belong to the city and remain at the property

25. Signature*

    Type in your name as it appears on your drivers license. Your name constitutes acknowledgement that the information provided is true and you are authorized to disconnect this service.

27. Customer Service Representative Signature
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field