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2. CITY OF MIDLAND TERMINATION REQUEST
   
   
   Use this form to Terminate Utility Services with the City of Midland. The City of Midland will process your termination request within two business days. Once this form is submitted, you have up to the day of the Termination to call and cancel, or re-schedule your request.
   
   Please be aware that this termination request can only be processed within 10 days of the requested termination date, and will be completed at anytime between 8am and 5pm on the requested termination date.
   
   
4. *Any credit balance will be processed and mailed to the forwarding address within 30 days of the final bill due date.
6. Requested Termination Date
   Requested Termination Date
8. Account ID*
   Example: 12345-67890
10. First Name on Account*
12. Last Name on Account*
14. Termination Service Address*
    This is the Address you are requesting to Terminate.
16. Forwarding Address*
    Street Address, City, State, and Zip Code
18. Forwarding Phone Number*
20. Email Address*
22. Name of Person Requesting Termination*
24. Today's Date
    Today's Date
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field