Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Email for & UTILITY (WATER/TRASH) DISCONNECT REQUEST FORM Client Information Name on Account *FirstLastOwnership *RentOwnerService Address *Email *Phone *Forwarding Address *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDate of Disconnect *Reason for Disconnect *Selling PropertyMovingTemporarily AwayDemolitionPlease Read & Acknowledge *Bills are generated for the previous months usage and the final billing will be a minimum of 30 days AFTER the disconnection date. A $50.00 disconnect fee will be assessed and applied to the final months billing. Final bills will be deducted from deposits and refund checks will be mailed to the forwarding address above. If this is a temporary disconnect request (less than 6 months), a temporary disconnect fee of $200.00 plus a $50.00 turn on fee will apply.Submit Download Utility (Water/Trash) Disconnect Here Post navigation Frontier Communications Driving Safety Course (DSC)