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2. Please note:
   If you enter today's date or a weekend or holiday date, your service cancellation will be effective on the next business day.
3. Date to cancel service*
   Date to cancel service
   Water services will be turned off anytime between 8 a.m. - 5 p.m. on the date selected.
5. Customer Name*
6. Account Number*
8. Service Address*
10. Forward Mailing Address*
12. Forwarding City*
13. Forwarding State*
14. Forwarding Zip Code*
16. Home Telephone*
17. Work Telephone*
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

* indicates a required field