DISCONTINUE SERVICE REQUEST
PO BOX 4009 * 7412 Emerald Drive Emerald Isle, NC 28594 Office: (252)354-3307 Fax: (252)354-2563
NOTE: THIS FORM IS TO END YOUR WATER SERVICE
NAME OF ACCOUNT HOLDER:
Your answer
ACCOUNT NUMBER:
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SERVICE ADDRESS: *
Your answer
DATE TO DISCONTINUE SERVICE(please choose a week day) *
MM
/
DD
/
YYYY
FORWARDING ADDRESS FOR FINAL BILL: *
Your answer
YOUR ELECTRONIC SIGNATURE IS TO VERIFY YOUR REQUEST TO DISCONTINUE WATER SERVICE WITH BOGUE BANKS WATER CORPORATION *
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