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Disconnection of Services 2019

  1. header-disconnection

  2. Customer Information

  3. Elgin, Texas 78621

  4. note-disconection

  5. I understand that by typing my name above, I am authorizing the Utility Billing Department to disconnect my services on the date indicated.

  6. Leave This Blank:

  7. This field is not part of the form submission.