Termination of Utility Service - Residential

Termination of Utility Service - Residential
Today's date

MonthDayYearHourMinutesAM/PM Option
Last day you are responsible for account

MonthDayYear
Service Address
Apt #
Select One:
If you are renting the home to a tenant, would you like monthly copies of their utility bill?
The property owner is ultimately responsible for the water and sewer bills on the property. You will automatically receive copies of delinquent letters and disconnection notices.

Current Account Information
First Name
Last Name
Forwarding Address (IF moving to another Baxter address please submit an application for the new address in Baxter)
City, State and Zip
Primary Phone #
Type...
Alternate Phone #
Type...
Email Address

New Owner/Tenant Information (If known)
First Name (new owner/tenant)
Last Name
Billing Address
Primary Phone # (new owner/tenant)
Type...
Alternate Phone #
Type...

Additional Information/Terms of Service
Comments/Additional Information
Should be Empty: