[City of Gastonia] Disconnect Service Application

Translate

ON MOBILE DEVICES AND TABLETS, THIS APPLICATION WORKS BEST IF THE DEVICE IS TURNED IN A LANDSCAPE POSITION.

Current Account & Service Location to be Disconnected:

To place a request to disconnect services at your current location, please complete all information below and allow at least two (2) business days for us to process your request.

Please note that we cannot process disconnect requests more than twenty (20) calendar days in advance. Thank you!

8-Digit City of Gastonia or Two Rivers Utilities Account Number:

Account First Name & Middle Initial

Account Last Name

Account Verification - please enter the last four digits of the SSN or TIN on your existing City of Gastonia account. If you did not previously provide your SSN or TIN, please complete a new Identity Verification form (found on the City's website).

Date to Disconnect Services - disconnects are only available during normal business hours, Monday-Friday (excluding holidays). Please allow 2 business days for processing.

Daytime Phone Number

Please enter valid email address to receive confirmation of your application:

Please note that your disconnect date is based on your application. It is the customer's responsibility to notify the City of any changes to dates or to the forwarding address for the final bill.

Customer Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.