CITY OF FOLKSTON
Water, Sewer & Garbage Account
Disconnection Request
Today’s Date ______________________ Cell Phone ______________________________
Customer Name ________________________________________________________________
Disconnect Address _____________________________________________________________
Account Number ______________________ Date of Disconnect ________________________
You may be entitled to a refund, therefore we ask you to provide an accurate mailing address.
NEW Mailing Address ____________________________________________________________
City ___________________________________ State _________ Zip ____________________
New Phone Number ____________________________ New Cell _________________________
Customer Signature _____________________________________________________________
============================== OFFICE USE ONLY =================================
ACCT NO. ______________________________ CUT OFF DATE _________________________
BY ______________ READING ____________________________________________________
NOTES
______________________________________________________________________________
OFF
W/O
ENTERED
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signature
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