DISCONNECTION REQUEST

All requests must be made in writing and received in the office no later than three working days prior to the requested cut-off date. Your service will be disconnected on the date that you request unless that date falls on the weekend or a holiday. In that case, we will disconnect the service on the following business day during the morning hours. All questions must be answered and this form must be signed. The forwarding address will be used for mailing a final bill or a refund check.

Name on Account: (required)

Service Address: (required)

Cut-off Date: (required)

Forwarding Address: (required)

Email Address: (required)

Telephone Number: (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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