Request Termination of Service

"*" indicates required fields

Note: This form will only be processed if request is made by the current customer(s) at the service address. If you prefer, you may instead print and mail or deliver this form. [ Printable Version ] I am requesting service to be terminated at the following service address. I understand that I may request any date in the future to terminate service, but LMUD requires at least 24-business hours to complete the request. If I back-date this request, LMUD will correct the date to the earliest available date to disconnect service.

Name*

First Last

Service Address*

Street Address Address Line 2 City State ZIP Code

Effective Date*

Selection date must be Monday thru Friday excluding Holidays and (1) business day following Today’s Date

Please send my final bill and/or refund to the following address:

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I am aware that my water, wastewater, and/or reuse service will be terminated at the above service address on the above date between 8:00am and 5:00pm. If I need to change the above date, I understand I am responsible for calling LMUD at 512-261-6222 at least one (1) business day prior to the requested termination date and will submit a new Request for Termination of Service form. I am aware that LMUD will charge a $50.00 service fee to reschedule to another date, reconnect service, or cancel the termination request if I do not notify LMUD at least one (1) business day prior to the requested termination date.

FOR AUTO-DRAFT CUSTOMERS ONLY

I would like my final bill to be auto-drafted per my method on file as soon as my final bill is available.

If left un-checked we will email and/or mail your final bill as soon as it is available.

Signature

Date

Phone*

Email*

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

Completing this form does not automatically terminate recurring bank/credit card drafting. To terminate automatic drafting prior to your final bill being drafted, fill out the “Cancel Automatic Drafting” form or contact the District Office. Otherwise, we will remove your automatic drafting once your account has a zero balance.

Phone

This field is for validation purposes and should be left unchanged.

Lakeway Municipal Utility District

Customer Support

Quality Matters

Six Years