***** PLEASE READ CAREFULLY *****

I, the undersigned, request that the utilities at the above address be discontinued on the date I specified in this Service Disconnection Form.

I understand that any balance that is owed after my deposit has been applied is due within 30 days upon receipt of my final bill. I further understand that failure to pay any money owed to the Utilities Board of Tuskegee will result in my account being turned over to a collection agency, and that I will also be responsible for court costs and attorney fees.