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

    This field is not part of the form submission.

34. Submit

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