Disconnect Form

Please submit all requests in advance of the desired completion date. NEMEPA does not guarantee same day service. Customers failing to submit a request in advance may incur additional service fees. Please note during periods of high volume, connects take priority. Disconnect requests may not be completed on the date requested. Please make sure all heating/cooling units, lights, and appliances are turned off when leaving.

Disconnect Service

Date to Disconnect Service - Mon-Fri (mm/dd/yyyy)*

Account Number*

Name on Account*

First Last

Address to Disconnect*

Street Address City State ZIP Code

Forwarding Information

For Deposit Refund Check

In care of:

Forwarding Address*

Street Address City State ZIP Code

Home Phone Number

Cell Phone Number*

Email*

Disconnect Form

Disconnect Service

Forwarding Information

Address

Phone Numbers

Normal Business Hours

Connect