2. 

4. Commercial Service Disconnection Request

6. 24 Hour Notice Required - Monday - Friday Only
   ***COMMERCIAL ONLY***

8. Date Service to End
   Date Service to End
10. Business Name
12. Service Address
14. Forwarding Address
16. City
17. State
18. Zip Code
20. Email
22. Did you sell property?*

    1. Yes
    2. No
23. If yes, to whom?
25. Did you rent property?*

    1. Yes
    2. No
26. If yes, to whom?

    Name of Tenants here

28. Is your bank account drafted?*

    1. Yes
    2. No
29. If yes, do you want the final bill to draft?*

    1. Yes
    2. No
33. Please be advised:

    Water could be turned off as early as 7:00 a.m. on disconnection date. Deposit will be returned after 4-6 weeks.

34. Initial Here
36. PLEASE NOTE: IF YOU ARE THE OWNER AND SELLING, IN ORDER TO TAKE THE SERVICE OUT OF YOUR NAME AND STOP RECURRING MONTHLY CHARGES, YOU MUST DEMONSTRATE A CHANGE OF OWNERSHIP.
38. Initial Here

42. By my signature below, I acknowledge that I have read and agree to the above listed conditions and any questions have been answered satisfactorily. I also understand that the water service could be turned off as early as 7:00AM on the disconnection date.

44. 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.
46. Electronic Signature
47. Date
    Date
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field