Water/Sewer/Garbage Form: Termination Form

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Date to END Water/Sewer/Garbage Service:

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Service only available Monday through Friday

Account Number:

Termination Request: *

Water

Sewer

Garbage

Name on Account: *

Service Location: *

Forwarding Street Address: *

Forwarding City: *

Forwarding State: *

Forwarding Zip Code: *

Phone Number: *

for example: 000-000-0000

Email Address: *

Special Instruction:

Acknowledgement: *

I understand by signing this form that the indicated services with City of Dawsonville Water/Sewer and/or Garbage will be terminated.

I understand I will be responsible for monthly services billing until the date of termination.

I understand that any outstanding bills will be deducted from my security deposit and the balance refunded or billed to me. If my account is set up with Direct Withdrawal, the City will collect the balance through ACH.

Date:

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Signature: *

Water/Sewer/Garbage Form: Termination Form

Contact Information