Discontinuance of Service – City of Walhalla

City of Walhalla Discontinuance of Service

To discontinue your water service with the City please fill out the form below. You will receive a final bill that will include water used up until the date of discontinuance.

Name (As appears on your account)*
First Last
Service Address*
Street Address Address Line 2 City State ZIP Code
Account Number*
Date of Discontinuance*
MM slash DD slash YYYY
Forwarding Address*
Street Address Address Line 2 City State ZIP Code
Final Bill Acceptance*
I understand that I will receive a final bill that will include water used up until the date of discontinuance. This final bill and any other correspondence will be mailed to the forwarding address you provided on this form. By checking this box I acknowledge that I have read the terms above and have willing filled out and agreed to discontinuing service. Put your initials in the box below and that will act as your signature.
I agree and accept
Initials (First and Last)*