Antioch, CA · Contra Costa County
Water Service Disconnection Form
This form lets Antioch water account holders request service disconnection and provide account, service, forwarding, and contact information.
What this form is
Water customers use this form to request disconnection of service and give the city their account number, requested service end date, service address, name, identification details, and reason for cancellation. It also asks for a forwarding address and contact information. The form states that requests are scheduled for the next business day unless a later date is provided, and same-day service requires a fee.
Who needs it
A person authorized to update an Antioch water account should complete this form when requesting water service disconnection.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the applicant just signs and dates it, and the form mentions no notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the Antioch Water Service Disconnection Form PDF.
- 2
Complete The Form
Fill in the required account, service, cancellation reason, forwarding address, and contact information.
- 3
Sign And Date
The authorized applicant signs and dates the form.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Antioch Water Service Disconnection Form for?
- It lets an authorized water account holder request that service be disconnected and provide account, service address, requested end date, forwarding address, and contact details.
- What information does the disconnection form request?
- The form asks for the account number, service end date and address, name, identification details, reason for cancellation, forwarding address, and contact information.
- Do I need a notary for the Water Service Disconnection Form?
- No. The form has an applicant signature and date line but no notary block; the applicant just signs and dates it, and no notarized or sworn attachment is mentioned.
- How do I submit the Water Service Disconnection Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Water Service Disconnection Form doesn’t need a notary — but if you have another Antioch form that does, a commissioned online notary can help.