Water Off Form

Account Information
Customer Name*
First Last
Account Number
Service Address*
Street Address Address Line 2 City State ZIP Code
Turn Water Off
- Yes
- No
Date of change
MM slash DD slash YYYY
Email Address*
Turn off instructions
Forwarding Address
Customer Name
First Last
Telephone Number
Service Address
Street Address Address Line 2 City State ZIP Code
* If the Town Office is not notified of your moving date, your deposit may not be refunded. If there is a balance owed, your deposit will be applied to the balance first before any refunds are made.
Sign Here*
First Last
Consent*
I agree to electronically sign and to create a legally binding document between the other party and myself, or the entity I am authorized to represent.*