Stop Service at My Home/Apartment/Business

2. Name on the Account (only account holder may request to stop service)
4. First Name*
5. Middle Initial
6. Last Name *
8. Address Where Service is Being Stopped*
9. Apartment number (if applicable)
11. City*
12. State*
13. Zip Code*
15. What date do you need service stopped?*
    What date do you need service stopped?
17. Forwarding Address
19. Address*
21. City*
22. State*
23. Zip Code*
25. Phone Number*
26. Email *
28. Acknowledgement

    Submittal of this application indicates agreement to allow the City of Ankeny to stop service at the above address on the date entered on this form. 

    Note: Phone number is required so we may contact you if we have questions. 

30. I understand and acknowledge the statement above.*

    Type first and last name to sign digitally.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field