SERVICE TERMINATION REQUEST FORM

SERVICE TERMINATION REQUEST FORM

A request for service termination must be received at least 24-hours before the requested termination date, not including weekends or holidays. Service terminations are performed Monday through Friday 8:00 AM - 3:00 PM only.
Move out Date*

MonthDayYear
Date
Account Number
Address where service will be terminated*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Why is service being terminated at this address?*

My current lease/rental agreement will expire on the move out date specified.I have sold this house and I am moving elsewhere.I am moving out of this house and renting it to someone else.
Final balance will be taken out of your deposit and the difference wil lbe mailed to the forwarding address.
Forwarding Address*

Street Address

Street Address Line 2

CityState

Zip Code
By clicking submit, I acknowledge that all services provided by the Seis Lagos Utility District at the above address will cease on the date I specified. I understand that the final balance will be deducted from my water deposit, and any remaining difference will be refunded to the forwarding address provided. I also acknowledge that any outstanding balance is due upon receipt.
Signature*

Powered by Jotform Sign Clear
Should be Empty: