You will receive your final bill following the cycle after services have been disconnected.Customer Information Last Name * First Name * Contact Phone Number * A phone number is required in case we need to contact you and verify information. Email Address Provide your email address to receive a copy of your request. Account Number * Location of Meter ( 911 Address) Street Address * City * State * Zip Code * Meter # to be disconnected * Preferred Disconnection Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201220132014 Disconnection service is available Monday - Friday. Billing Address Street Address * City * State * Zip * Forwarding Address Street Address City State Zip Comments Comments By submitting this form, you accept the Mollom privacy policy.
