Water Service Disconnect Application

If you recently moved away from Story City, we want to wish you well and ask you to fill out our application to disconnect your water service with the city! If you moved within Story City, please fill out this form to notify us of the address that needs to be disconnected from our water service.

Your Information

Account Number(Required)

Name(Required)

First Last

Phone(Required)

Date of Disconnect(Required)

Current Address(Required)

Street Address City ZIP Code

Forwarding Address(Required)

Street Address City ZIP Code

Do you rent or own?(Required)

Rent

Own

Landlord Name(Required)

Landlord Phone(Required)

Please Note: Water service can’t be transferred to the new owner until the new owner contacts us.

Signature(Required)

Today's Date(Required)

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Water Service Disconnect Application

Your Information

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