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PO Box 158
Bainbridge, GA 39818
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  • Phone: (229) 248-2000
  • Fax: (229) 246-7311
  • Staff Directory

Utility Service(s) Termination Request

 Step 1 of 1

This form is used to terminate utility services.

Do not report emergencies with this form!
Dial 9-1-1 for all emergencies!
 
Prior to the termination of any services, City Hall must receive a photocopy of the Customer's Identification. Please fax the Indentification to (229) 246-7311 to the attention of the BILLING COORDINATOR.

* Denotes a required field
 

Customer Information

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Social Security Number*
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Daytime Telephone 
-- ext
Evening Telephone 
-- ext
Mobile Telephone 
-- ext
*
*Your Utility Account Number can be found on your bill. We MUST have this number to process this request.

Requested Services

*
Would you like to terminate your water service?*
If yes, when would you like your water service terminated? 
 If yes, when would you like your water service terminated?
Would you like to terminate your Natural Gas services?*
If yes, when would you like your Natural Gas services terminated? 
 If yes, when would you like your Natural Gas services terminated?

*Please type in all capital letters to electronically sign.
*
Date*
 Date
 



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