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Closure of Account Form
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Closure of Account Form
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Account Number
*
Phone
*
Email
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Date and Time to turn off water
*
Date
Time
Reason for Closure
*
Refund Type (Cheque/Direct Deposit)
Transfer to Another PWC Account
Direct Deposit
Local TCI Bank Details
First Caribbean
Scotiabank
RBC
Bank Account Number
Name on Bank Account
*
Alternative PWC Account Number
Comment or Message
Signature
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 Signed
Date
Time
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