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2. APPLICATION FOR TERMINATION OF WATER SERVICE
4. ACCOUNT TERMINATION DATE*
   ACCOUNT TERMINATION DATE

   Please select date you would like to request water service terminated. Terminations can be done as soon as the next business day. No same day terminations are available. Terminations cannot be done on the weekends, only Monday - Friday.

6. ACCOUNT NUMBER*
8. CUSTOMER FIRST NAME*
9. CUSTOMER LAST NAME*
11. COPY OF PHOTO ID*

    Customer must upload a copy/photo of a current picture ID.

13. SERVICE ADDRESS*
15. PHONE*
16. EMAIL ADDRESS*
20. FORWARDING ADDRESS:*
22. City*
23. State*
24. Zip*
26. ELECTRONIC SIGNATURE AGREEMENT*

    1. I agree.

    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.

28. APPLICANT SIGNATURE*
29. DATE
    DATE
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field