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Utility Disconnect Request

2. Name

4. Phone Number

6. Email Address

8. Disconnect Date
   Disconnect Date

10. NOTICE*

    Please note: if your disconnect request falls on a Friday, Saturday, Sunday or holiday, your disconnect will be dated for the first working day. For suspended services requests (extended vacations or vacancy), per LMC 15.56, you will continue to be charged for stormwater, water base charge and sewer base charges. In addition to these charges, there is a $50 turn on fee once you return and need water restored.

    1. Acknowledged
12. Service Address

14. City

15. State

16. Zip Code

18. Account Number

20. Forwarding Address

22. City

23. State

24. Zip Code

26. Reason for Disconnect

28. Comments

Leave This Blank:


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

    This field is not part of the form submission.

32. Submit

* indicates a required field