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2. Name*
3. Account Number*
5. Tax ID Number
7. Service Address*
9. Forwarding Address*
11. City*
12. State*
13. Zip Code*
15. Email Address*
16. Phone Number*
18. Date of Disconnect*
    Date of Disconnect
    Monday-Friday
20. • If there is a deposit on file, the deposit will be applied to the Final bill. Any credit still left on the account will be sent in the form of a check to the forwarding address provided.
22. • Email or fax this form back to: businessoffice@schertz.com / 210-619-1139 FAX
24. • Submitting this form does not guarantee services are disconnected until you receive a confirmation of disconnection back via email. If you need a same day disconnection please contact our office at 210-619-1100.
26. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
28. Electronic Signature*
29. Date*
    Date
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field