UTILITY SERVICES DEPARTMENT
Barefoot Bay Water & Sewer
931 Barefoot Blvd, Suite 2
Barefoot Bay, FL 32976
Request for Termination of Service
Requestor name ________________________________ Account # _____________________
Service address ______________________________________________________________
Service termination date _____________________________
I understand that the deposit, if applicable, will be applied to this account, and a final bill will be
generated for this address. If there is a balance due, I agree to pay this balance upon receipt of
the final bill. If there is a credit balance, this refund will be mailed to the forwarding address as
Forwarding Address ___________________________________________________________
If service is requested at this address from the above-named person, family member or real
estate agent, I understand there will be back billing of the base rate for each month this remains
vacant, payable before service is restored. A new Customer Service Request form must be
submitted along with a copy of driver’s license and a new deposit if applicable.
I certify this home is unoccupied.
I authorize Brevard County Utility Services, Barefoot Bay Water & Sewer District Department to
discontinue water service at the address listed above.
Signature ________________________________________ Date _______________________
Phone (772) 664-5916 ● Fax (772) 664-5941