Request to Terminate Utility Service

Account Holder Name: Account Holder Name: * First Last
Account Number *

If you are terminating a commercial account, you may input the federal ID number
Service Address Service Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Desired Disconnection Date Desired Disconnection Date * / MM / DD YYYY

We are unable to accommodate same day service.
Phone Phone * - ### - ### ####
Email *
Please provide the address where your final bill and/or any potential refund check should be mailed:
Name Name * First Last
Mailing Address Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
By signing below, I understand and agree to the following:
-Final Bill: My deposit will be applied to my final bill.
-Additional Charges: I agree to pay any interim charges or the final bill amount that is greater than my deposit.
-Refund Processing: If my final bill is less than my deposit, a refund check will be mailed to the address provided above within six to eight weeks after termination of my services.
-Responsibility for Balance: If my deposit is less than the final bill, I am responsible for paying the remaining balance. Failure to pay any balance due may result in the account being delivered to a collection agency, and I agree to pay any associated collection or legal fees incurred by Starkville Utilities.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
Photo Identification MUST be Provided

Approved Forms of Photo Identification:
Driver license / Passport / Student ID

Please note if you are on a mobile device and experiencing issues uploading your images, the problem may be the high resolution that your camera is taking these pictures. Please take the picture first and store it on your camera roll. Once stored in your camera roll, most pictures will have been auto-optimized to a size that our software can support. You can then select the picture to upload from your camera roll. Taking a picture in real time generally will result in the file size being too large to upload to our servers. However, selecting the picture from your camera roll will resolve the issue.
Upload a File ( Photo ID) *

Attach Files

If you take a photo with a mobile camera, save it first to your camera roll before attempting to upload!

Request to Terminate Utility Service

Request to Terminate Utility Service

Please provide the address where your final bill and/or any potential refund check should be mailed:

Photo Identification MUST be Provided