Disconnection of Water and Sewer Services

Instructions

Complete this form. (All are required fields)
Mail, email, fax, or upload a copy of your picture ID.
(Contact information appears at bottom of this page.)
Please note, there is a $20 charge for turning ON/OFF your water service.
All Requests will be processed on the next business day. City Hall is closed on Friday.

* Required Fields

Customer Information

* Name of person requesting closing

Use Above Name

Not Same

* Name of person on bill

* Driver's License No:

Account Information

* Current Water Account #:

* Service Address

* Service City:

* Service Zip:

Forwarding Information

* Forwarding Address

* Forwarding City:

* Forwarding State/Province:

* Forwarding Zip/Postal Code:

* Email Address:

* Phone Number:

* Cell Phone Number:

REQUEST DATE to Disconnect WATER

* Disconnect Date:

Signature Information

This application will not be signed in the traditional sense of a paper document. To verify the contents of this application, the signatory must enter their name preceded and followed by the forward slash (/) symbol. The City of Coconut Creek presumes that the specific entry has been adopted to serve the function of the signature.
Example: /John Doe/

* Signature:

I am aware that there will be a service charge for disconnection of water service, and that my deposit will be applied to my final water bill.

Contract Information - Questions?

Call us at 954-973-6732
Fax: 954-973-6754
Email Customer Service
Upload: Use a WeTransfer account. (Use utb@coconutcreek.net for friend's email)
Mail: Water Services, 4800 West Copans Road, Coconut Creek, FL 33063