Keene, TX · Johnson County
Disconnect Request Form
Keene account holders use this form to request service disconnection and provide account details, a requested disconnection date, and forwarding information.
What this form is
Use this form to ask the City of Keene to disconnect services and terminate an ACH draft. It requests account holder and account details, service and forwarding addresses, a requested disconnection date, and the account holder’s signature and date; include a copy of the account holder’s identification or driver’s license. Disconnection dates are not available on Saturdays or Sundays.
Who needs it
An account holder requesting service disconnection from the City of Keene should complete this form and include a copy of their identification or driver’s license.
How to submit it
Return the completed form to Keene City Hall, 1000 N. Old Betsy Rd, Cleburne, Texas 76031; it may also be faxed to 817-556-2060 or emailed to [email protected].
About notarization
This form is signed and dated without a notary; include a copy of the account holder’s identification or driver’s license, which the form does not say must be notarized.
How to submit this form
- 1
Download The Form
Download the Disconnect Request Form PDF.
- 2
Complete The Form
Enter the requested customer, account, service address, forwarding address, and disconnection date information, then sign and date the form.
- 3
Gather The Required Copy
Include a copy of the account holder’s identification or driver’s license.
- 4
Submit To The City
Return the form to Keene City Hall, or fax or email it using the contact details listed on the form.
Frequently asked questions
- Do I need a notary for the Disconnect Request Form?
- No. The account holder signs and dates this form without a notary. Include a copy of the account holder’s identification or driver’s license; the form does not say it must be notarized.
- How do I submit the Disconnect Request Form?
- Return it to Keene City Hall at 1000 N. Old Betsy Rd, Cleburne, Texas 76031, fax it to 817-556-2060, or email it to [email protected].
- What should I include with the request?
- Complete the form and include a copy of the account holder’s identification or driver’s license. The form asks for customer and account information, addresses, a requested disconnection date, and a signature.
- Can I request disconnection for a Saturday or Sunday?
- No. The form states that disconnection dates are not available on Saturday or Sunday.
Need something notarized?
This Disconnect Request Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.