Hold On Account

I authorize the Charles Town Utility Board to final my account while I am away, so that I am not billed for service during this time. I understand that I will need to supply verbal consent to restart the account once I have returned.

Name on Account

Account Number

Address for Service

Address Line 1

Address Line 2

City

State

Zip Code

Date to begin hold

Please choose one:

I require the technician to turn off the service
I will be turning off the service myself

Date

Picture Identification

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