Berwick Electric Disconnection Request
Name
*
First Name
Last Name
Your Berwick Electric Account Number
*
Forwarding Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Disconnection (we do not disconnect on weekends and Holidays).
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: