Rocky Mount, VA · Franklin County
Termination of Utility Services
Customers use this form to request turning utility services off or on and provide account, service address, forwarding address, and signature information.
What this form is
This form lets a customer indicate whether to turn utility services off or on and provide a date to discontinue service. It asks for the account number, name on the account, service and forwarding addresses, comments, and the customer's signature and date. The form also includes fields for office use, including deposit release and final account information.
Who needs it
A customer who wants to turn utility services off or on and provide account and address details should complete this form.
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 customer just signs and dates the request.
How to submit this form
- 1
Download The Form
Download the Termination of Utility Services form.
- 2
Complete The Form
Mark turn off or turn on, enter the requested service and account details, and sign and date the form.
- 3
Gather Attachments
No attachments are listed on this form.
- 4
Submit To The City
The form does not state where to submit it; check the city website for current contact details.
Frequently asked questions
- What does the Termination of Utility Services form do?
- It lets a customer indicate whether utility services should be turned off or on and enter a discontinuation date, account number, and address details.
- What information does the form ask for?
- It asks for the account number, name on the account, service address, forwarding address, comments, and the customer's signature and date.
- Do I need a notary for the Termination of Utility Services form?
- No. This form is signed and dated by the customer without a notary, and it lists no notarized attachment or related step.
- How do I submit the Termination of Utility Services form?
- The form does not give submission instructions. Submit it to the city department named on the form and check the city website for current contact details.
Need something notarized?
This Termination of Utility Services doesn’t need a notary — but if you have another Rocky Mount form that does, a commissioned online notary can help.