Please use this form to request the discontinuation of your electric service.

Customer Information

Your Name:

Forwarding Address:

Forwarding Phone Number:
Location of Service

Property Owner's Name:

Apartment/Trailer No.:

Location of Dwelling:


Account Information

Electric Account Number:

Date Disconnect is to be Effective:

Disconnects are not made on Saturdays, Sunday, or Holidays

By submitting this form, you certify that all of the information on this form is true and complete to the best of your knowledge and that you are the customer named above.