Fillable Disconnection Request (City of Pooler)

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Disconnection Request (City of Pooler)

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CITY OF POOLER
UTILITY BILLING DEPARTMENT
100 US HWY 80 SW,
POOLER, GEORGIA 31322
PHONE: 912-748-4800
Disconnection Request
Name __________________________________________________________________
Address_________________________________________________________________
Contact Phone Number____________________________________________________
Email __________________________________________________________________
Today’s Date ____________________________________________________________
Cut Off Date _____________________________________________________________
Forwarding Address_______________________________________________________
________________________________________________________________________
Customer Signature ______________________________________________________
For Office Use Only
Account No. ___________________________ Date received ______________________
Entered By: ____________________________ Date entered _______________________
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Disconnection Request (City of Pooler)

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Completed 4 August 2020

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