Hernando County Utilities

HERNANDO COUNTY UTILITIES

REQUEST FOR TERMINATION OF SERVICE
* FORM MUST BE COMPLETED IN IT'S ENTIRETY TO PROCESS

* DEPOSITS ARE APPLIED TO YOUR FINAL STATEMENT/BILL, ANY CREDIT BALANCE WILL BE REFUNDED TO THE ACCOUNT HOLDER

* OVERTIME CHARGES MAY APPLY FOR SERVICE REQUESTS AFTER 3:30PM

**$50 Service Fee will be applied to Turn Off Services**
NAME ON ACCOUNT*

First NameMiddle NameLast Name
HERNANDO COUNTY UTILITY ACCOUNT NUMBER *
AA12345-00
SERVICE ADDRESS*
Street Address
PHONE NUMBER*

Area CodePhone Number
EMAIL*
example@example.com
SELECT THE REASON FOR TERMINATION OF SERVICE*

SEASONALPERMANENT
REQUEST DATE FOR TERMINATION (EXCLUDING WEEKENDS & HOLIDAYS)*

MonthDayYear
Date
FORWARDING MAILING ADDRESS. REQUIRED FOR REFUNDS AND/OR FINAL BILL.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: