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Seasonal Shut Off and On Form

  1. CWM_LOGO-RGB_Web 2

  2. SEASONAL SHUT OFF AND ON FORM

  3. No weekends or holidays

  4. No weekends or holidays

  5. I acknowledge that the City will retain any security deposit on my account during the seasonal discontinuance and that upon my return, I will be required to pay a service charge fee of $30.00 as set forth in Section 58-94 of the City of West Melbourne Code of Ordinances. The seasonal discontinuance of service shall be granted for a period not shorter than two months or longer than six months. Monthly charges totaling $13.66 (water $7.10, sewer $6.00 and $0.56 utility tax) shall be billed to my account. For those customers that have reuse available, the $14.19 monthly fee will also be billed.

  6. Type your name

  7. MAILING ADDRESS:

  8. Leave This Blank:

  9. This field is not part of the form submission.