Termination of Utility Services Request

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To terminate service of your utility services account with the city of Buckeye, please complete the termination of services information below.

Or, you may print and email the form to utilitybilling@buckeyeaz.gov. To request a form by mail, please contact the Utility Billing Department by calling 623-349-6100.

Downloadable PDF of termination form

Your requested disconnect date cannot be prior to today's date. Request must be submitted by account holder and will take a minimum of three working days for processing.  Please note that you are responsible for all services (water, sewer or trash) until we receive and process your termination request.

Please correct the field(s) marked in red below:

1
Today's Date:
 *
2

Disconnect Date (Mon-Thurs):

(DD/MM/YYYY)

 *
Property Information:
3
Property Address: (Include City, State, Zip Code)
 *
4
Property Address City
 *
5
Property Address State
 *
6
Property Address Zip Code
 *
Customer #1
7
Name (Last Name, First Name):
 *
8
DOB:
 *
9
Last four digits of SSN or Tax ID:
 *
10
DL/ID:
 *
11
Phone #:
 *
12
Email:
 *
13
Forwarding Mailing Address:
 *
14
Forwarding Address City:
 *
15
Forwarding Address State:
 *
16
Forwarding Address Zip Code:
 *
17
Forwarding Phone Number:
 *
18
Reason for Termination:
Reason for Termination:
19
 I/we declare under penalty of perjury under the laws of the State of Arizona that all information is true and correct.  I have the lawful authority to disconnect utility services for the address identified on the submittal; I am accepting all financial responsibility for the utilities account, and I agree that I will remain financially responsible for the utility account until it has been paid in full. 
 *
20
Signature of Customer #1 (Typewritten signature accepted)
 *

Our normal business hours are Monday through Thursday, 7 a.m. - 6 p.m.. Forms received in our office or on-line, after 6 p.m., Monday through Thursday will not be processed until the following business day. 

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