City of Mattoon
Water Disconnect Form
Questions?
Please call us at: 217-235-5483
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Account Number
*
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Final Bill to be mailed to:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Service End Date:
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: