START TEMPORARY DISCONNECT FORM - LCU Service Request

For those residents who plan on leaving their home on a temporary basis.

Those who are considering temporarily vacating their premise cannot close their utility account, the Owner of Record is responsible for the monthly base charges for utilities services on all residential properties.

Hard Disconnect: A resident requesting a hard disconnect will have the meter turned off and will incur a $45 charge for disconnection. Monthly base charges will continue to be assessed for each service at the location. Upon the request of the customer, service will be turned on at the meter on the date requested, or the nearest business day. A re-connection charge of $45 will also be incurred when the service is rendered.

Customer Information

Last Name*

First Name*

Lee County Utilities Account Number

Hard Disconnect Start Date*

DL, FEIN, or ID No.*

For security purposes.

Service Address*

Apt/Unit

City*

State*

Zip Code*

Provide Contact Phone Number*

Note: Enter your Email above if you would like to receive a confirmation email

An electronic or manual signature is required when submitting this form. Write your name in the signature area to submit this form electronically (acceptable per Florida Statue 668.50). If an electronic signature is not possible, the form may be printed, signed and submitted in person, via FAX, or by a scanned copy sent via e-mail.

I agree that all information on this form is true and accurate to the best of my knowledge.*

Signature*

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