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Customer Service

Imperial Irrigation District

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Please correct the fields below:

Disconnect Service

Please correct the field(s) marked in red below:

To disconnect service, please complete the following fields and click submit form.

1

Customer Name:

*

Customer Name:

2

Contract Account:

*

Contract Account:

3

Service Address:

*

Service Address:

Street Address

City

State

Zip

4

Service Disconnection Date:

*

Service Disconnection Date:

5

Last Four Digits of Social Security Number/Federal Tax ID:

*

Last Four Digits of Social Security Number/Federal Tax ID:

6

Mailing Address for Final Bill:

*

Mailing Address for Final Bill:

Street Address

City

State

Zip

7

Primary Contact Phone Number:

*

Primary Contact Phone Number:ext.

8

Secondary Contact Phone Number:

Secondary Contact Phone Number:ext.

9

Email:

*

Email:

10

Comments: (Provide details, such as, how to access the meter)

Comments: (Provide details, such as, how to access the meter)

*Required Field

To receive a copy of your submission, please fill out your email address below and submit.
Email Address