Gold Country Stop Service Request

Gold Country Stop Service Request

We require a minimum of 48-hours notice to schedule turn-offs along with this completed form. Please note that there is a $26.00 charge to stop service.

Requested Date for Turn Off

A minimum of 48-hours notice is required for service requests. (Office hours are 9-4 Monday through Thursday; requests made on Thursdays or Fridays will not be scheduled until the following week.)

Requested Time for Turn Off

Full Name of Person Submitting Request

Contact No. of Requestor

CWS Property Service Address

Select or enter value

Owner's First Name

Owner's Last Name

Owner's Address (if different than property)

Owner's City

Owner's State

Owner's Zip

Owner's Contact No. 1

First/Last Name of Person Present

Contact No. of Person Present

Stop Service Request

Select

Service Agreement Acknowledgement

By submitting this form, I hereby state and certify that I have an interest in the property identified here, and I direct Gold Country Water Co. to shut off water service to the property. I also state and acknowledge, and agree to assume any and all responsibility for any damage to or in the property that may result from the shut off of the water service. I further agree to waive any right to any claim or liability against Gold Country Water and release them from any damage to or loss on the property as a result of Gold Country's action in accordance with this request. (Upon agreement check the box and submit this form.)

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