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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
12. Forwarding Information

    Please provide the forwarding address for your final bill. If a resident, DO NOT ENTER YOUR CURRENT ADDRESS.

14. Name*
16. Contact (if billed to company or an organization)
18. Address*
20. City*
21. State*
22. Zip Code*
24. Contact Phone Number*
25. Contact Email*
27. 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
29. 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
31. 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
33. Name of Individual Authorizing Account Termination*
34. Date*
    Date
36. Enter the account number from your bill for the account you wish to terminate:
38. Route Number*
39. Service Address ID*
40. Resident Number*
42. 
46. Upon completion and submittal of you application for a disconnection of services, you will be returned to the Utility Billing page for the Town of Northlake's website. Please contact Utility Billing with any questions or concerns.
Leave This Blank:


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

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field