Fillable Application to Discontinue Utility Service (City of Veneta)

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Application to Discontinue Utility Service (City of Veneta)

On average this form takes 6 minutes to complete

The Application to Discontinue Utility Service (City of Veneta) form is 1 page long and contains:

  • 2 signatures
  • 4 check-boxes
  • 16 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Veneta

BROWSE CITY OF VENETA (OR) FORMS

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Instructions:
1. Complete this form in its entirety; sign form.
2. Submit form to City by one of the following methods:
Check one: OWNER
Name on Account Account #:
Service Address: Phone #:
Forwarding Address: City: St: Zip:
Sold to: Phone #:
Phone #:
TEMPORARY SHUT OFF
Local Emergency Contact Information:
Name:
Phone #:
Form Signed?
Owner/Propery Mgmnt:
a) In person: 88184 8th Street, Veneta
b) Fax to: (541) 935-1838 Attn: Utility Billing.
c) Mail to: P.O. Box 458, Veneta, OR 97487
Check the box below that applies and provide the additional information:
RENTER
3) Transfer to another Account:
FOR UTILITY BILLING ONLY
Service Order Created?
Identity checked and indicated on form?
PO Box 458 * Veneta, OR 97487 * 541-935-2191 * Fax 541-935-1838 * www.venetaoregon.gov
Form complete?
Applicant Signature:
Co-applicant Signature:
By My/Our Signature Below I/We Verify that the information provided on this form is true and accurate.
If you are not the owner, please provide the Owner/Property Management Co. name
DISCONTINUE SERVICE DATE:
2) Forfeit: **
Service Reinstatement Date:
Deposit Released By:
MOVING/SELLING
1) Refund:
Application to Discontinue
Utility Service
S:\FORMS\Utility Billing\Discontinue Service Request Application 4/3/2018
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Application to Discontinue Utility Service (City of Veneta)

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Completed 17 July 2020

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