REQUEST FOR TERMINATION OF SERVICE

I, __________________________________ am requesting service to be terminated at the following service address__________________________________ effective_________________________, (Monday thru Friday excluding Holidays).   I understand that I may request any date in the future to terminate service, but I cannot stop service prior to today.  If I back-date this request, the District will correct the date to the date it receives the request.  Please send my final bill and/or refund to the following address:

_______________________________

_______________________________

(Address Required)

I am aware that service will be terminated at the above service address on the above date between 8:00 am and 5:00 pm .  If I need to change the above date, I will contact Lakeway Municipal Utility District at the number listed above at least one (1) day prior to the requested termination date and complete a new request form.  If service is terminated before I request a new turn off date, I am aware that the District may be charge a $50.00 service fee to reconnect service.  I am also aware that it can take up to 2 months to receive my final bill.  Completing this form does not automatically terminate recurring bank/credit card drafting.  To terminate automatic drafting, please contact the District Office.

If you mail or fax this form, it is your responsibility to verify that we received it.

Lakeway Municipal Utility District
1097 Lohmans Crossing
Lakeway, TX 78734
512/261-6222
512/261-6681 fax 
(please call to verify receipt of fax)