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Termination of Utility Service Request

2. Please complete the online form below to terminate utility service. Service will be terminated on the date you request, or within 3 business days.

4. Date you wish to Terminate Services:*

6. Property Address:*

8. City*

9. State*

10. Zip*

12. Primary Applicant's Name:*

14. Forwarding Mailing Address*

16. City*

17. State*

18. Zip*

20. Home Phone Number*

21. Cell Phone Number

23. Employer*

24. Work Phone*

26. Email Address

27. Driver's License Number/State*

29. Secondary Applicant's Name

31. Roommate

    1. Roommate
32. Spouse

    1. Spouse
34. Mailing Address

36. State

37. City

38. Zip

40. Home Phone

41. Cell Phone

43. Employer

44. Work Phone

46. Email Address

47. Driver's License/State

49. I agree and acknowledge by clicking the box below that I am disconnecting my utility service with Kittitas PUD. I understand that I am fully responsible for any charges incurred at the location listed above until the date of termination. I agree to have my current charges paid in full at time of termination, and my final balance paid within 30 days of termination. I understand failure to pay all final charges could result in being sent to collections.*

    1. I Agree and Acknowledge the above statement.
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit Submit and Print

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