Fillable WATER OFF REQUEST Administration Finance 362 N. Third (City of Stayton)

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WATER OFF REQUEST Administration Finance 362 N. Third (City of Stayton)

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Administration • Finance
362 N. Third Avenue • Stayton, OR 97383
Phone: (503) 769-3425 • Fax (503) 769-1456
WATER OFF REQUEST
Services Order # ___________ Account #_____________
Meter Read ___________________
Today’s Date: __ ______
Turn off Date:
Customer Name:
Business Name:
Services Address:
Forward Address: ________
City: State: Zip Code:
Phone Number:
Renting Selling Dormant
Transfer Balance to Acct#:
Transfer Date:
Owner’s Name:
Owner's Phone#:
Final Balance Owed:
"This Institution is an equal opportunity provider"
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WATER OFF REQUEST Administration Finance 362 N. Third (City of Stayton)

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Completed 24 January 2021

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