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2. Please complete the online form below to cancel your utility account.

4. Upon Termination, any deposit paid and previously not returned will be applied to the final bill. Any remaining deposit will be refunded to the mail forwarding address on this form within four to six weeks. 

6. Personal Information
8. Select type of service address*
   -- Select One --ResidentialBusiness
9. Today's Date*
   Today's Date
10. Date Moved/Sold Property*
    Date Moved/Sold Property
12. First Name on Account*
13. Last Name on Account*
15. Account Number
17. Phone Number*
19. Email Address*
21. Reason For Canceling*
    -- Select One --Sold PropertyMoving out of EphraimMoving to new location in EphraimOther
23. Service address being canceled*
25. Is this a rental?*

    1. Yes
    2. No
26. If it is a rental, who is your landlord?
28. Mail Forwarding Address*
30. Please type your name to verify cancelation*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field