Disconnection Form for Service
NOTICE: By clicking "Submit" above, you are acknowledging this is a request for Disconnection of service. You will receive a Final Bill and remaining balance will be due thirty (30) days after disconnection.
Additionally you acknowledge that all “Finaled” or “Inactive” accounts with balances shall be paid in full by the due date of the Final Bill. Failure to pay the balance of a “Finaled” or “Inactive” account shall result in the account being referred to a Collection Agency after the account is delinquent over 60 days. Should litigation be necessary, I understand I will be responsible for any and all legal and court fees and/or penalties assessed by the adjudged court or Town of Annetta should judgment be against me.
Finally, by clicking "Submit", I am in still under contract with the Town of Annetta to pay in full the remaining balance of my water bill, I acknowledge I have read the above Notice, understand the contents and agree to contents within.