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2. Only the person listed on the account must complete this form and return it to the Gainesville Department of Water Resources. There will be a $15 charge for this service.

   Contact information: email, [email protected]; telephone, 770-535-6878; in person or by mail, 757 Queen City Parkway, Gainesville, GA 30501

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