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Discontinue Service Request Form

  1. Customer Information

  2. Address where service is being discontinued at

  3. This is the date you would like services disconnected. Please choose a day between Monday and Friday.

  4. Does your utilities account include any additional carts over the one (1) solid waste and one (1) recycling cart that comes standard with City of Robinson solid waste services?*

  5. Last Bill Information

  6. This needs to be a good mailing address that mail can be sent to once services have ended.

  7. Customers Acknowledgement

  8. AGREED AND UNDERSTOOD:

  9. Relationship to the account holder (if you are not the account holder making the request):

  10. Leave This Blank:

  11. This field is not part of the form submission.