Residential Disconnect Service

Discontinue Service Application
Date of Request*

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date to Disconnect Service*

MonthDayYear
Date
Account Number*
Same day disconnection service request

Monday- Thursday before 2:00 pm

Friday 7:30-10:00 am

Any request submitted after hours stated will be processed on the next business day
Please provide the City of Melissa with your new mailing address. This information will be used to mail your final bill and/or your deposit refund check.

To make a request to discontinue service, you must provide a copy of your state- issued photo ID.
Upload a Copy of your State-issued photo ID*

Cancelof
Address to Disconnect Service*
Forwarding Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
For your convenience, we offer Electronic Funds Transfer (EFT), for your deposit refund if applicable. Please click here to set up EFT on your account.
EFT
Signature*

Clear
Should be Empty:

Discontinue Service Application