2. Disconnection Request for Services with the City of Pierre
4. Date*
   Date
   enter today's date
5. Date Services End*
   Date Services End
   enter the date you want services to end
6. The date for services to end must be today or later. For prior dates, please contact City Hall 773-7407 or utilities@ci.pierre.sd.us.
8. Name*
9. Landlord
11. Email Address*
13. Service Address*
14. Phone Number*
16. Forwarding Address*
    enter the new address to send your utility deposit refund and final bill
18. Deposit Refund Checks will be mailed to this address. Checks are not processed for less than $5.
20. I understand that if I do not return my City issued Landfill Recycle key fob by the date of service disconnection, I will be charged $25 fee for the replacement of the lost card.
22. I understand that refunds less than $5 are transferred to Pierre Area Referral Service.
24. The above listed customer requests that their utility services from the City of Pierre are to be discontinued as of the requested date listed above. Customer is responsible for all bills and charges at this address until the requested date as listed above.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field