SNEW: South Norwalk Electric and Water > Forms > Request to Disconnect Service

Request to Disconnect Service

Printable Form, Request to Disconnect Service Form (PDF)

Date to terminate service*
Date Format: MM slash DD slash YYYY
Is this a rental property?*
- Yes
- No
Contact name for landlord or property manager*
First Last
Account Holder and Service Location
Account Holder Name*
First Middle Last
Service Address*
Street Address Address Line 2 City State ZIP Code
Forwarding Mailing Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone Number*
Secondary Phone Number
Email address*