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2. Date
4. First Name
5. Last Name
7. Property Address
9. City
10. State
11. Zip
13. Phone Number
14. Water Service Account number
16. Emergency Contact & Phone Number
18. Date service should be restored
22. The Fine Print
    Submit this request at least 24 hours in advance.
24. Instructions
    * Completely close the main water valve by the meter on your side of the line.
    
    * Verify that water service has actually been shut-off; Cranberry will not be responsible for damages or water charges if the shut-off has not occurred.
    
    * Curb box problems may delay shut-off on the date requested.
    
    * A minimum base rate will continue after water service has been shut-off.
    
    *There is a $50 charge that covers both shut-off and restoration of service. This charge will appear on your next monthly bill.
    
    * Once water service has been shut-off, it will not be restored unless the owner or the owner's authorized agent is physically present at the timeservice is restored.
28. By checking the "I agree" checkbox below, I acknowledge that I accept the above conditions and request the Township to turn water off to the property whose address appears on this form.
30. Check box to agree*

    1. I agree

    By checking the "I agree" box, I acknowledge that I accept the above conditions and request the Township to turn water off to the property whose address appears on this form.
33. Name
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field