Section 1 of 3 in this document

REQUEST TO DISCONNECT GILBERT UTILITY SERVICE

IMPORTANT! WATER SERVICE MAY BE DISCONNECTED AS EARLY AS 5AM!

Please include a forwarding address to ensure you receive your final statement. Unpaid bills are sent to a collection agency and reported to the credit bureau agencies.

Section 2 of 3 in this document

Disconnect Date

Please select the date you would like to disconnect service. You will be billed through this date.

The date can be changed up to 1 business-day prior (before 6pm) without any additional fees.

If you need to re-activate service once the water has been disconnected, you will be charged an activation fee and additional payments and fees may be required prior to reconnecting water.

Only the primary or secondary account holder may disconnect service for the utility account or an authorized representative if a business account.

Provide Account Number if Known

Requestor's Information. Person completing this form is the...

Social Security Number (Please provide the last 4 numbers as a minimum)

Please provide a good contact phone number

Provide the GILBERT address you are DISCONNECTING service at

Address or Location

Do you have a burglar alarm registration at this address that needs to be canceled?

Yes

I have the authorization to disconnect service at this property and close the utility account.

Yes

REQUEST TO DISCONNECT GILBERT UTILITY SERVICE

Please include a forwarding address to ensure you receive your final statement. Unpaid bills are sent to a collection agency and reported to the credit bureau agencies.

Customer Name (Name on Utility Bill)

Please Enter Your Name

Provide the GILBERT address you are DISCONNECTING service at

Complete if you have a Forwarding Address

Do you have a burglar alarm registration at this address that needs to be canceled?

I have the authorization to disconnect service at this property and close the utility account.