Form Center

2. Disconnect Services

   To have your current water, sewer, and any trash or recycling services cancelled, please fill out the following form. Please allow 1-2 business days to process your request. 

   Please contact Utility Billing at utilitybilling@town.northlake.tx.us or 940-648-3290 with any questions. 

6. Service Address to Be Disconnected*

   Please provide the service address you wish to be disconnected.

8. Service Type*

   1. Residential

   1. Commercial

   1. Fire Hydrant Meter
10. Requested Service End Date*
    Requested Service End Date
11. PLEASE DO NOT CHOOSE A HOLIDAY OR WEEKEND.

    Disconnects will not be completed on a holiday or weekend. If a disconnect is submitted for a holiday or weekend, the disconnect will be scheduled for the next available business day. 

13. Forwarding Information

    Please provide your forwarding address for the return of any remaining amount of the $150 Water Deposit that was paid when services first began. 

    If a resident, DO NOT ENTER YOUR CURRENT ADDRESS.

15. Name*
17. Contact (if billed to company or an organization)
19. Forwarding Address*
21. Forwarding City*
22. Forwarding State*
23. Forwarding Zip Code*
25. Contact Phone Number*
26. Contact Email*
28. Account Privacy*

    With your authorization, the Town of Northlake can withhold the release of your personal information (i.e. phone number, social security number, address) pursuant to Section 182.052 of the Texas Utilities Code. Would you like the Town of Northlake to keep your information confidential?

    1. Yes, keep my personal information confidential
    2. No
30. Billing Options*

    Your final utility bill can be sent via e-mail or postal service. Please choose how you would like to receive your bill. Select all that apply.

    1. Send my bill via e-mail
    2. Send my bill via the postal service
32. Authorization of Account Termination*

    I agree and understand that I am terminating my services and I am responsible for this account and all bills must be paid on or before the due date or be subject to late charges. Any deposit credit will be refunded via check and sent to the forwarding address provided above.

    1. Yes, I agree to the above statement
    2. No, I do not agree to the above statement
34. Name of Individual Authorizing Account Termination*
35. Date*
    Date
37. Enter the account number from your bill for the account you wish to terminate:
39. Route Number*
40. Service Address ID*
41. Resident Number*
43. 
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field