Termination of Service (Utility Billing)

2. Please read and complete the information below. Utility Billing can be reached at 407-703-1727.

   Please read and complete the information below. Utility Billing can be reached at 407-703-1727.

4. Date of Submission*
   Date of Submission

6. Name*

   First and Last Name

7. Account Number*

9. Service Address*

11. City*

12. State*

13. Zip Code*

15. Phone Number*

16. Email Address*

18. Date Service to be turned off*
    Date Service to be turned off

    City of Apopka Utilities requires a 24 hour notice of disconnect. Disconnections are only processed Monday through Friday.

22. Forwarding Address Information
    Please fill out the forwarding address information for this account.

    Please fill out the forwarding address information for this account.

24. Name*

    First and Last Name

26. Address*

28. City*

29. State*

30. Zip Code*

32. Email Address*

33. Phone Number*

35. Request Submittal
    I hereby request that my service with City of Apopka Utilities be terminated on the date requested. I understand if I need to change or extend the disconnection date, I must contact City of Apopka Utility Billing at 407-703-1727, at least one (1) business day prior to the original request date. I understand any deposit on my account will be applied to my final bill after the stated due date. Any amounts remaining will be refunded and a check mailed to the above forwarding address.

    I hereby request that my service with City of Apopka Utilities be terminated on the date requested. I understand if I need to change or extend the disconnection date, I must contact City of Apopka Utility Billing at 407-703-1727, at least one (1) business day prior to the original request date. I understand any deposit on my account will be applied to my final bill after the stated due date. Any amounts remaining will be refunded and a check mailed to the above forwarding address.

39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree. Electronic Signature
41. First, Middle, & Last Name*

    Please type your full name.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field