Utility Termination Request

Utility Termination Request
General Guidelines
- Valid photo ID is required on the form. Please upload a copy when prompted and attach it to the application.
- Please note it can take up to three business days to process your submission.
- Fields with marked with a red asterisk (*) must be completed.
Important*

All information provided as part of this form will be stored by a third-party service provider. If you do not wish to provide personal information such as your SSN or ID# on the JotForms site, we require that you provide them in person at the Utility Billing office. To view details regarding the security measures put in place by JotForms, please visit: https://www.jotform.com/security/
OFFICE USE ONLY
Click Next to go to OFFICE USE ONLY fields

Utility Termination Request

** Please note that we bill one month behind. This means you will be receiving at least one bill after you terminate your account **
Customer Name (must be an account holder to terminate utilities)*

First NameLast Name
Utility Account Number (optional)
Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Service Termination Details
Disconnect Date*

MonthDayYear
Date selected needs to be Monday through Friday and cannot be the current day.
Number of Garbage Cans at Property*
Number of Recycling Cans at Property
Please Leave Empty Cans Outside of Garage.
Are you relocating to somewhere within Eagle Mountain City?*

YesNo
Forwarding Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please complete a new Application for Utilities to start services at your new address.

OFFICE USE ONLY