2. 
4. City of Waynesboro Application for Terminating Utility Services

   Residents or Businesses terminating water, sewer, and trash services must complete this Service Application. 

   A final bill will be issued at the beginning of the next month and be sent to the most recent billing address.  If you do not receive your final bill please contact us. 

   Deposits will be applied to the final bill.  Remaining balances must be remitted.  Remaining credits will be refunded to the most recent billing address.

   Please contact the City of Waynesboro Utilities Office at 942-6643, Option 4, if you have any questions Please allow 24 Hours (M-F, 8-5) for your request to be processed.

6. Are You:*

   1. Renting
   2. Own
7. Service Stop Date*
   Service Stop Date
9. Last Name*
10. First Name*
11. Middle Initial*
13. Social Security or Driver's License Number*
    If you are a business please put Federal ID # or EIN #
15. Business Name
16. Business Phone Number
20. Service Address
22. Address # and Street*
23. Apt. or Unit #
25. City
26. State
27. Zip
29. Mailing Address for Final Billing
31. Address # and Street*
32. Apt. or Unit #
34. City*
35. State*
36. Zip*
40. Phone #*
41. Email Address
43. Stopping Garbage Service*

    1. Yes
    2. No
44. # of Cans To Be Removed*
46. NAME OF PERSON COMPLETING APPLICATION*
    Please Note: Only the Account Holder and Authorized Users can make changes to the Utility Account
47. Date and Time of Application
    Date and Time of Application

    Date and Time of Application
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field