Discontinuing Utility Service

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(Minimum 5 Day Notice Required)
Applicant Name(Required)
Service Address(Required)
New or Forwarding Address(Required)
Check Refund Made Out to (Name)(Required)
Refund Check ACH/Direct Deposit(Required)
I am interested in setting up direct deposit/ ACH for my deposit refund. (If box is checked "YES" Accounts Payable will contact you to set up this service).
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This field is for validation purposes and should be left unchanged.