FILLABLE Termination Request

Travis Co. W.C.I.D. - Point Venture 18606 Venture Drive Point Venture, TX 78645

Phone: 512-267-1641 Fax: 512-267-0818 Email: Office@wcidpv.org Office Hours: Monday-Friday 8:00 am - 4:00 pm Lobby Hours: Monday-Friday 8:00 am - Noon

Request For Termination Of Service
I,
be terminated at the following service address
Effective

MonthDayYear
Date
(Monday through Friday excluding holidays)

Please send my final bill and/or deposit refund to the following address:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I am aware that service will be terminated at the above service address on the above effective date between 8:00 am and 4:00 pm. If I need to change this termination date, I will notify the District Office at the above number and/or address at least three days prior to date of termination request form. If service is terminated before a new turn off date is requested, I am aware that I may be charged a $100.00 service fee to reconnect.
Customer Signature

Clear
Date

MonthDayYear
Date
Should be Empty: