Request to Discontinue Utility Service

2. Utility Account Number

3. Date of Service Cancellation
   Date of Service Cancellation

5. Service Address 1

7. Address 2

9. City

10. State

11. Zip

13. First Name

14. Last Name

16. Forwarding Mailing Address 1

18. Address 2

20. City

21. State

22. Zip

24. Home Phone

25. Cell Phone

27. Signature

28. Date
    Date

30. Deposit Information
    The deposit you paid to the City of Farmersville will be returned to you after 1st applying it to your final bill. Any remaining deposit amount will be mailed to the forwarding mailing address given.

    The deposit you paid to the City of Farmersville will be returned to you after 1st applying it to your final bill. Any remaining deposit amount will be mailed to the forwarding mailing address given.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field