Utility Disconnection Request

Submit this form to request and schedule a utility service disconnection. This form is also available as a printable PDF.

Customer Information

First name (given name)
Last name (surname)
Provide the Business Name if applicable. Leave blank for residential service disconnection.
The account number is available on the utility bill.
Service Address
City
State/Province
Zip/Postal
Country
Enter the street address where the service needs to be disconnected.
Forwarding Mailing Address
City
State/Province
Zip/Postal
Country
Enter your new mailing or forwarding address.
Select your preferred disconnect date. Disconnection services are only available Monday-Friday, excluding state holidays.
Disconnection services are available in either the morning or afternoon.
Other notes or special instructions.
Enter your full legal name.
Sending