Please enable JavaScript in your browser to complete this form.Name *FirstLastAccount Number *Phone *Email *Address *Address Line 1Address Line 2CityState / Province / RegionDate and Time to turn off water *DateTimeReason for Closure *Refund Type (Cheque/Direct Deposit)Transfer to Another PWC AccountDirect DepositLocal TCI Bank DetailsFirst CaribbeanScotiabankRBCBank Account NumberName on Bank Account *Alternative PWC Account NumberComment or MessageSignature Clear Signature By signing this form, I am requesting that Provo Water Company (PWC) discontinue water service to the above mentioned service address and close my account. I am also acknowledging the following: (1): PWC will prepare a final bill and forward a final account statement to my email address. (2): PWC will apply any credits that I have on this account to this final bill. If the final statement has a credit balance or there is a deposit on this account, PWC will refund within 10 days. (3): If there is a balance due on the final account statement, the entire balance is due and payable upon receipt and delinquent after 14 days from the date on the statement. (4): PWC has the right to forward your account to the Collections Department to recover the outstanding balance and any associated fees.Date SignedDateTimeSubmit