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Account Information

Date Requested for Termination*
Date Requested for Termination
Reason for Termination*
1. Moving Outside the City
2. Moving to Another Location Within the City
3. No Longer Have Listing on Property
4. Property Sold (a copy of the closing statement and warranty deed must be emailed to CustomerService@Titusville.com)
5. Property Foreclosed
6. Other
If "Other", specify:
New Account Number (if moving to new location within the City)
Is the service address to be terminated/suspended completely unoccupied?*
1. Yes
1. No
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I understand that:
By signing this form, I am requesting that my services with the City of Titusville Utility Department be terminated as of the date that I have requested.
I will be responsible for paying all service charges generated up to the date that I have requested above.I understand that the final bill will be deducted from my deposit and that the credit balance will be refunded to me via the forwarding address that I have provided.
I also understand that the refund process will take 4 to 6 weeks to receive a check in mail. I understand that if the balance on my final bill exceeds my deposit, I will be responsible for paying the balance in excess of my deposit.I understand that I must either provide a copy of my valid driver’s license or a government issued photo identification in order to complete the request for termination. A notarized termination request form may be submitted in lieu of photo identification.
I have read, understood and agreed to the City’s policy for termination of service.*
1. Check to Agree
Date & Time*
Date & Time
Date & Time
To Complete This Form:
You must additionally email a copy of your drivers license to CustomerService@titusville.com.

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