Request to Stop Water Service

Notification to Municipal Billing Specialist is due one (1) week prior to stop service date.

For questions regarding water utilities please contact the Municipal Billing Specialist at (608) 723-6225.

Legal Name(s) *

Phone Number *

Secondary Phone Number

E-mail Address

Driver's License / State Identification or Passport Number *

Date to Stop Service *

Service Address *

Landlord's Name (if applicable)

Reason for Stop Service * Selling
Renter Moving Out
Other (please explain below)

Forwarding Address for Final Bill *

Additional Information (optional)

WAVIER. I, the owner, agent, or tenant of the property stated above, hereby informs the Lancaster Water & Sewer Department that the person named above is moving out and is responsible for the final water / sewer utility bills at the above mentioned service address and that the final bill should be sent to the forwarding address listed.

CONSENT TO RELEASE INFORMATION. Pursuant to and in accordance with WI Stat. Sec. 196.137, the Lancaster Water and Sewer Department is hereby authorized to release my/our customer account number, usage, and status information to the landlord / landowner. (Please note: A landlord / landowner will receive copies of all delinquent notices sent.)

Acknowledgment * I hereby agree to the Waiver and Consent to Release Information stated above.

* - denotes required field