Service Removal Form

Elexicon Account Number*

Meter Number*

Date Service Can be Removed*

Property Owner Information

Name*

Telephone Number*

Email*

Authorized Requestor Information

Name*

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*

Comments

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

Elexicon Energy

Elexicon Energy

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Property Owner Information

Authorized Requestor Information