CITY OF FALLON
SERVICE TERMINATION REQUEST
TURN OFF DATE
SERVICE ADDRESS
TERMINATED CUSTOMER’S FORWARDING ADDRESS
NAME
ADDRESS
CITY
STATE
ZIP
PHONE
SIGNATURE
DATE
FOR OFFICIAL USE
ACCOUNT NUMBER
COMPUTER ENTRY BY
DATE
Please fill out & sign the following form digitally, or print and fill out. Then, submit it with one of the following methods:
1. Scan and email to: clerksoffice@fallonnevada.gov
2. Fax to the City of Fallon: 775-423-8874
3. Print and bring into the City of Fallon Clerk's Office.
click to sign
signature
click to edit