Wellston, OH · Jackson County
Termination of Water Service Agreement
Wellston customers use this agreement to request water service disconnection and provide account, requested disconnection, and forwarding-billing information.
What this form is
This agreement lets a customer request termination of water service for an account at a Wellston service address. It asks for the customer’s name, phone number, account number, requested disconnection date, whether occupants will remain, and a forwarding address for final billing. The customer acknowledges responsibility for charges through the disconnection date and signs and dates the request.
Who needs it
A customer requesting water service termination for a Wellston account can use this agreement to provide service and final-billing details.
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 agreement is signed and dated without a notary; the form lists no notarized attachment or related sworn step.
How to submit this form
- 1
Download The Agreement
Download the Termination of Water Service Agreement PDF.
- 2
Complete Customer Information
Enter the customer name, service address, phone number, and account number.
- 3
Add Termination Details
Provide the requested disconnection date, indicate whether occupants will remain, and enter a forwarding address for final billing.
- 4
Sign And Submit
Sign and date the agreement, then submit it to the city department named on the form.
Frequently asked questions
- What does the Termination of Water Service Agreement do?
- It lets a customer request water service termination for an account and provide a requested disconnection date and forwarding address for final billing.
- What information does the agreement ask for?
- It asks for the customer’s name, service address, phone number, account number, requested disconnection date, whether occupants will remain, and forwarding address.
- Do I need a notary for the Termination of Water Service Agreement?
- No. The customer signs and dates the agreement without a notary, and the form lists no notarized attachment or related sworn step.
- How do I submit the water service termination agreement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Termination of Water Service Agreement doesn’t need a notary — but if you have another Wellston form that does, a commissioned online notary can help.