HomeMy WebLinkAboutRequestForService-DiscontinueServiceTenantREQUEST FOR SERVICE – DISCONTINUE SERVICE-TENANT
City of Oshkosh Utilities ● 215 Church Ave, Oshkosh, WI 54901
Email: utilitybill@oshkoshwi.gov Office: (920) 232-5325
INSTRUCTIONS: This form MUST be COMPLETED in its entirety and returned to the Utility Accounting Department in
order for your request to be processed.
* Include your FINAL BILL mailing address.
* Include a telephone number where you can be reached during business hours.
* Owner or Tenant Authorization is Needed (Only One)
* Service requests are for future dates only
Account Number:
(if known)
SERVICED PROPERTY INFORMATION (REQUIRED)
Address:
City/ST/Zip:
Move Out Date:
PROPERTY OWNER INFORMATION
Property Owner Name:
Phone:
Landline: Cell Phone:
Name 2: Email:
Mailing Address (if different from Property Address): City/ST/Zip:
TENANT FINAL BILL INFORMATION (REQUIRED)
Tenant Name:
Phone:
Landline: Cell Phone:
Address for Final Bill:
City/ST/Zip:
Lease End Date:
Tenant Email:
I understand that I am responsible for all utility charges incurred at this location until I provide notice that I have moved
and am no longer responsible for this utility bill.
Signature: Owner Tenant
Date:
Office Use Only
Signature: