Termination Form

Service Address

Unit #/P.O. Box

City/Town

State/Province

ZIP/Postal Code

Country

First Name

Last Name

Account Number

Move-Out Date

NOTE: We require a minimum of 2 business days notice prior to the date of change. Readings will be done on the next business date where the ownership change date falls on a weekend or a holiday. Current customer is responsible for charges up to time the final reading is completed. Service termination will occur between the hours of 7:30 a.m. and 4:00 p.m. Monday to Friday (excluding holidays).

Please provide your new address forwarding information.

Address

Unit #/P.O. Box

City/Town

State/Province

ZIP/Postal Code

Country

Telephone

E-Mail Address

Customer Identification

I am the owner of the service address.

I am the tenant of the service address.

Landlord Name

I hereby request E.L.K. Energy Inc. to terminate electrical service to the premises at the above address. I hereby further agree to pay for service at the authorized rates to the date on which the service is terminated. Final statements are payable on or before the due date. All accounts not paid by the due date are subject to a late payment charge, as well as collection action including disconnection and payment of a reconnection fee.

Signature

Sign above

Date