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2. Utility Service Disconnection/Reconnection Request

   Do not submit this form to request new service be started in your name or to request a final billing. 

   Service requests for disconnection/reconnection may be requested for repairs or seasonal service. All billing will remain active during the disconnection period.

   If you are requesting a permanent disconnection, the Utility will reduce the Water Fixed Fees to the Water Standby charge of $7/month ($14/billing cycle) and discontinue the Sewer Fixed Fees. However, if reconnection is requested within one year, you will be back-billed for the duration services were disconnected. All garbage fees will remain in effect unless the property will be demolished.

   All Reconnection Requests are subject to a $75 reconnection fee.  

4. Service Address or Account Number:*
6. Contact Information
8. Primary Name:*
9. Secondary Name:
11. Billing Address:
12. City:
13. State:
14. Zip Code:
16. Phone Number:*
17. Email Address:
19. Contractor Contact

    If Applicable

20. Contractor Phone Number

    If Applicable

22. Please Schedule my services to be disconnected on:
    Please Schedule my services to be disconnected on:

    Please Schedule my services to be disconnected on:

    We request someone to be on site for disconnections. Please specify a time between 7:00am-3:30pm to have services disconnected. 

23. Please Schedule my services to be reconnected on:
    Please Schedule my services to be reconnected on:

    Please Schedule my services to be reconnected on:

    We will require someone to be on site for reconnections. Please specify a time between 7:00am-3:30pm to have services reconnected. 

25. I understand there is a $75 fee for reconnection requests during business hours (7:00am-3:30pm) and $150 after hours. *
    -- Select One --Yes
27. Please provide any additional information regarding your request
29. Change Form Submitted By:*
30. Date:*
    Date:
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field