Stop Service Agreement Form

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All fields with an asterisk * are required.

SERVICE INFORMATION

Service Type:

Residential

Commercial

Multifamily

Other

Reason to Stop Service:

Sold Property

Lease Ended

Tenant Moving In

Temporary Stop

Account Number *

Service Address: *

Effective Date: *

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(Last day of lease or closing date for sale) ** Service Changes cannot be completed on a weekend **

Effective Date Comments:

If needed, please describe any additional information about the effective date.

Once we turn the water off at the street the utility account will continue to be billed base fees. These charges are to help maintain the infrastructure. The City charges a $35.00 disconnect/restore fee for this service.

YOUR FORWARDING INFORMATION

Name on the Account: *

Forwarding Street Address: *

City: *

State: *

Zip: *

Phone Number:

Email Address:

Auto-pay Customers: After you stop your service, we will create your closing bill and the payment will be withdrawn on the 10th of the following month.

*Water will be turned off the morning of the effective stop service date.

WHO IS TAKING OVER RESPONSIBILITY OF THE SERVICE ADDRESS

Owner/Property Mgr Name:

Mailing Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

AUTHORIZATION TO STOP SERVICE

Signature: *

Date Signed:

Electronic signature agreement. By selecting the "I Accept" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a keypad, mouse, or another device to select an item, button, icon, or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgment, consent terms, disclosures, or conditions constitute your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

I Accept: *

Yes

Stop Service Agreement Form

Contact Information

Address

Phone

Hours