Request to Close Utility Account

2. Move Out Information
   If you were renting, we will hold the information submitted until the owner of the property makes contact.

   If you were renting, we will hold the information submitted until the owner of the property makes contact.

4. First Name*

5. Last Name*

7. Phone Number*

8. Email Address*

10. Current Service Address*

11. Move Out Date*
    Move Out Date

13. Forwarding Address*

15. City*

16. State*

17. Zip*

Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit Submit and Print

* indicates a required field