Service Removal Form - Elexicon Energy

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If you would like to permanently remove electrical service from your property, please complete the form below.

"*" indicates required fields

Elexicon Account Number*

Meter Number*

Date Service Can be Removed*

Meter Location*

Inside

Outside

Service Removal Address*

Street Address Address Line 2 City Postal Code

Property Owner Information

Name*

Mailing Address*

Same as Service Removal Address

Street Address Address Line 2 City Postal Code

Telephone Number*

Email*

Authorized Requestor Information

Authorized Requestor Name

Same as Property Owner Information

Name*

Mailing Address*

Same as Service Removal Address

Street Address Address Line 2 City Postal Code

PhoneTelephone Number*

E-mail*

Submitting this form consents to Elexicon disconnecting and removing the service from the property. Elexicon will complete this work within five (5) business days from the ‘indicated date service can be removed’ or date the form was received, whichever is the latter. Meters located inside the premise are an exception to this timeline and will require an appointment, subject to Elexicon’s availability.

Typing in your name below confirms your signature of this document.

Name*

Date*

This field is for validation purposes and should be left unchanged.