SERVICE DISCONNECT REQUEST

CITY OF COLUMBIA - CUSTOMER SERVICE

P.O. BOX 147, COLUMBIA, S.C. 29217 PHONE: (803) 545-3300 | FAX: (803) 733-8219
Service Disconnect Request

Residential account holders may complete this form to arrange disconnection of services. Final readings will be taken on metered services, within five business days of the termination effective date. Completed disconnect forms can be printed and faxed to 803-733-8219 or mailed to City of Columbia, Water Customer Service, P.O. BOX 147, COLUMBIA, S.C. 29217. A final bill will be mailed to account holder with the words “FINAL BILL.” Only bills marked “FINAL” terminate account holder’s financial responsibility for service.
Date

MonthDayYear
Date
Account Number*
Last Five of SSN*
Account Holder's Name*

First NameMiddle NameLast Name
Service Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Effective Date for Termination Request*

MonthDayYear
*Final readings are obtained within fivebusiness days from the effective date.
Final Billing Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Telephone*
Format: (000) 000-0000.
Type of Phone

HomeWorkMobile
Best Time to Contact

AMPM
Email Address
example@example.com
Account Signature (Please Type Full Name)*
Today's Date*

MonthDayYear
Date
*A Customer Service Representative may contact you if additional information is needed. Requested information must match account information to process request.
Should be Empty:

Service Disconnect Request