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2. 
3. Stop Services - Rental Property

   Please complete the online form to disconnect water utility services. Additional questions may be needed complete a disconnection request. Contact the City of Lafayette Utility Billing for any questions by calling 303-665-5588 or email utilitybill@lafayetteco.gov.

   Automatic Withdrawal Information

   The automatic bank draft withdrawal will be removed on all final bills and another form of payment will be required. This does not apply to automatic payments set up through your online portal using a debit or credit card.

5. Today's Date*
   Today's Date
6. Disconnection Date*
   Disconnection Date
   Today's date or a future disconnection date. We are unable to back date your disconnection services.
7. Account Number*

   00-0000-00

9. First Name*
10. Last Name*
12. First Name
    Co-Occupant
13. Last Name
    Co-Occupant
15. Rental Property Address*
17. Rental Property Address
19. City*
20. State*
21. Zip*
23. Forwarding Address*

    The City of Lafayette can only send a paper copy for disconnection services. Note that a final copy of the water bill will be sent to both tenant and landlord.

25. Address2
27. City*
28. State*
29. Zip*
31. Email Address*
33. Name of Landlord/Property Management Company*
35. Contact information of Landlord/Property Management Company
37. This form is being completed by:

    1. Tenant
    2. Landlord/Owner
    3. Property Management Company
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field