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Turn-Off Water Service Form

2. Only the person listed on the account must complete the form and return it to the City of Gainesville, Department of Water Resources. There will be a $10 charge for this service.
   Fax: 678-989-3379, Email: customerservice@gainesville.org, In person or by mail: 757 Queen City Parkway, Gainesville, GA 30501, Phone: 770-535-6878
4. Service Location Information
6. Customer Name*
7. Account Number*
9. Service Address*
11. City*
12. State*
13. Zip Code*
15. Address to Mail the Final Bill to:
17. Address*
19. City*
20. State*
21. Zip Code*
23. If your account is on landlord status, do you want to cancel the landlord status on this account?

    1. Yes
    2. No
    3. N/A
25. Please select the day you want your water disconnected. No turn offs on Friday or the day before a Holiday.

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
26. Requested Turn off Date*
    Requested Turn off Date
28. Person Filling Out Form
30. Your Name*
31. Phone Number*
32. Email*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field