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Town of Monument Water Connect Form

Please complete the online form below to submit your request.
Service Address*
Where would you like the water service disconnected?
City*
State*
Zip Code*
Residence Description*
Please select one of the following options.
1. Owner
2. Agent
3. Renter
Date Service to End*
Date Service to End
Continue

Owner Name*
Owner/Agent Phone Number*
Owner/Agent Mailing Address*
City*
State*
Zip Code*
Owner/Agent Email Address
PLEASE READ THIS AGREEMENT AND TYPE YOUR NAME BELOW:
The final meter read will occur on the end service date during regular business hours. You will be responsible for your final invoice. IF not paid in full according to the Connect Agreement, late charges will be added monthly until paid in full.
The undersigned hereby requests the Town of Monument to disconnect water service to the address designated herein. *

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