3. 
   

5. Sold My Property

7. Today's Date*
   Today's Date
9. Account Number
10. Account Name*
12. Service Address*
14. Phone Number*
15. Email Address*
17. Closing Date*
    Closing Date
18. Disconnection Date*
    Disconnection Date

    Please give the buyer at least 24 hours' notice to initiate their account after the closing.

19. Upload Closing Statement
    If the closing has already occurred, please provide a copy of the signed closing paperwork.
21. Did you stay in the property after the closing date?*

    1. Yes
    2. No
22. Comments

    If you stayed in the property after the closing date, please provide the date that you vacated the property.

24. Forwarding Address*
26. City*
27. State*
28. Zip Code*
30. New Owner's Name
32. Acknowledgement*

    I am aware that as the seller, I will be held responsible for all charges up through the day of the closing, regardless of whether the property is occupied or not.

    1. I agree.
34. Disconnection Fee*

    I am aware that there is a $25.00 service charge to the seller for disconnection of service. The buyer will need to provide a copy of the signed Settlement Statement, photo ID, and a contact phone number.

    1. I agree.
36. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
38. Electronic Signature

    
    

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field