Request to Disconnect Services
Customers are financially responsible for all account charges until the Water Billing Office is
notified in writing by the account holder to close the account (based on Sec. 37-43 of the Code of
Ordinances).
After the completion of this form, a service order will be generated and scheduled for
disconnection. The meter is read and a final bill is generated. Before deciding on a disconnect
date, please be aware that we will be out any time during the disconnect day to cut off the meter. If
you plan to do any cleaning you may want to schedule the termination of service for the next day.
The deposit, if any, is applied to the final billing. If the deposit exceeds the final bill, a refund will
be mailed to the forwarding address separate from the final bill. A 24-hour notice is required for
disconnection of service. If you want same day service, a fee of $25 must be paid in advance.
Name on Account: _________________________________________________________
Your Name (if different from above): __________________________________________
Account Number: ____________________________
Service Address: ___________________________________
Driver’s License #: __________________________ Contact Number: _________________________________
Email Address: ______________________________________________
Requested Effective Date (Required): _______/_______/_______ (Monday – Friday*)
* On Fridays, the office closes at 1 PM
_____________________________________________________________________________________________
Forwarding Information:
Mailing Address: ________________________________________________________________________________
City: ____________________________________ State: ____________ Zip Code _______________
Forwarding Contact Number(s): ______________________________________
_____________________________________________________________________________________
____________________________________________ _________________________
Customer’s Signature Date Signed
Once form is completed, you can fax, scan & email, mail or drop off in person.
City of Pasadena -Water Billing
P.O. Box 1337
Pasadena, TX 77501-1337
713.475.5566 – Office
713.475.4945 – Fax
wbcs@pasad
enatx.gov
FOR OFFICE USE ONLY:
Received ________________ (Date in Office)
Employee Initials __________
Service Order Created ____________ (Date)
click to sign
signature
click to edit
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