City of Canton Discontinue of Service Request Form

Account Number: *

Date To Disconnect: * +

Type: *

Sign Out Of Service

Temporary Sign Out Of Irrigation Service

Sign Out Transfer To

Sign Out Transferred To:

Email Address: *

First Name *

Last Name: *

Service Address: *

New Mailing Address: *

City *

State *

Zip Code *

Phone Number *

Attach Copy Of License or State Issued ID: *

Reason For Request: *

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Customer Signature: *

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