Required fields are marked with asterisks (*)

Account Closure — Owner

Service Information - The information collected will be used by the City of Belleville to establish and maintain a service connection and for billing and collection purposes.

Street Number

Street Name

Unit Number

Move Out Date

Last Name

First Name

Forwarding address:

Email Address

Telephone Number

Add another phone number

Yes

Telephone Number

If you have a refund on account would you like it processed via direct deposit?

Yes

I hereby confirm that the information contained herein is true and accurate and agree to the terms and conditions described.

Agree