"*" indicates required fields

Instructions: Fill out this form below and click the Submit button. Your request will be sent to the Utility Billing Department. A Fairview staff member will contact you by phone or email to verify your request within 2 business days.

Full Name*

First Last

Service Address*

Water Bill Account Number

Email*

Phone*

Forwarding Address*

Date of Service Stoppage*

Forwarding City*

Forwarding State*

Forwarding Zip Code