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2. Account Number
3. Customer Name*
5. Service Address*
6. Meter Number

8. I am the property owner of the above listed service address. This dwelling is vacant and I request that the water service be deactivated. The meter will be shut off and locked on the day I request, as long as it falls on a normal business day. I understand flat rates for water and sewer will continue to be billed until the date when the meter is deactivated. Storm water charges will continue as long as there are existing buildings, driveways, foundations, etc. There will be a charge to reactivate this service and flat fees will restart on that date.

10. Electronic Signature*

    1. By clicking this box you are signing this form electronically
12. Name*
    Please type name.
13. Date*
    Date
15. Phone Number*
16. Email Address*
18. Effective Date to Shut Off Meter*
    Effective Date to Shut Off Meter
19. Reason for Meter Deactivation*
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21. 1. Receive an email copy of this form.
22. Email address

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23. Submit

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