Utility Termination Application

The information below should be filled out as completely and fully as possible.

An email confirmation will be sent to you once the termination request has been submitted at the email address provided.

Customer Information

Customer First Name *

Customer Last Name *

Utility Account Number *

Service Address *

Service Address Line 2

City *

State *

Zip Code *

Do you: *

Own the Property

Rent the Property

Owner's Name (required if renting)

Owner's Phone Number (required if renting)

Forwarding Information

Forwarding Address *

Forwarding Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

Home Phone Number

Email Address *

Termination Information

Services to be Terminated (Please allow 3 business days from date requested.) *

Culinary Water

Garbage

Recycling

Secondary Water

Transfer / Closing Date *

Disconnect Date *

NOTE: Please provide Riverton City with a copy of your closing document.

Closing Document Upload (if available)

Customer Signature: *

clear

Today's Date * +