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Water/Sewer Disconnection Form
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TODAY'S DATE
*
TODAY'S DATE
FINAL ACCOUNT
ACCOUNT NAME
*
ACCOUNT NUMBER
*
PROPERTY ADDRESS
*
West Melbourne, FL 32904
TURN OFF DATE
*
TURN OFF DATE
(Water cannot be turned off on weekends or holidays)
EMAIL
FORWARDING STREET ADDRESS
*
CITY, STATE, ZIP
*
PHONE NUMBER
*
NOTE:
The Post Office will not forward your bill or deposit. You must change your address with the Utility Department.
SIGNATURE OF ACCOUNT HOLDER(S)
*
(Type your name/s as your signature)
DATE
*
DATE
2240 Minton Rd., West Melbourne, FL 32904
Phone: 321-837-7750 Fax: 321-768-2390
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