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2. 
3. WATER TERMINATION FORM
   Please complete this form to allow us to finalize your water account with the City of Nassau Bay.
5. This form must be submitted at least one business day in advance to allow us enough time for your account to be processed.
   Water Service will be shut-off if we do not have the new owner/renter’s information on file to establish new service in their name.
7. Name(s) on Account:
9. Service Address
11. Disconnect Date
    Disconnect Date
    (If date requested falls on a weekend, the account will be finalized on the following business day.)
13. Final Billing Address:
14. City / State
15. Zipcode
17. Name of Person Making Request:
18. Contact Phone Number:
20. Signature
    Please type your name acknowledging the above information you have provided is correct.
21. Today's Date
    Today's Date
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field