To terminate your utility account, please complete the form below: <form-template> <fields> <field type="date" required="true" label="Date" class="form-control calendar" name="date-1659043117792"></field> <field type="text" subtype="text" required="true" label="Customer Name" class="form-control text-input" name="text-1659043132037"></field> <field type="text" subtype="text" required="true" label="Service Address" class="form-control text-input" name="text-1659043142045"></field> <field type="text" subtype="text" required="true" label="Mailing Address" class="form-control text-input" name="text-1659043157329"></field> <field type="text" subtype="text" required="true" label="Phone Number" class="form-control text-input" name="text-1659043166409"></field> <field type="text" subtype="text" required="true" label="Email Address" class="form-control text-input" name="text-1659043175787"></field> <field type="date" required="true" label="Move out Date" class="form-control calendar" name="date-1659044416793"></field> <field type="text" subtype="text" label="FOR OFFICE USE ONLY:" class="form-control text-input" name="text-1659043192570"></field> <field type="text" subtype="text" label="Account # ____________________" class="form-control text-input" name="text-1659043206971"></field> <field type="text" subtype="text" label="Meter Reading: ______________ Completed by: ________________" class="form-control text-input" name="text-1659043221373"></field> <field type="checkbox-group" label="Actions Taken" class="checkbox-group" name="checkbox-group-1659044132687"> <option selected="true">Final Bill Processed _____________</option> <option>Deposit Applied _______________</option> <option>Refund Processed _______________</option> <option>Final Bill Mailed ________________</option> <option>Refund Cheque Mailed ___________</option> </field> </fields> </form-template> Submit Submitting...