Water Disconnection Request

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1
Water Disconnection Date
 *
Please allot five (5) business days notice for water turn-on submitted by this form. If earlier turn-on is needed, please call 757-220-6188. We cannot backdate submissions. Water will be disconnected on requested date or first business day after information is received.
2
Service Address
 *
3
Name
 *
4
Account Number
 *
5
Forwarding Address
 *
Forwarding Address
6
Contact Phone Number
 *
7
Contact Email Address
 *
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