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3. 

5. Termination requests may only be processed Monday through Friday, excluding holidays. 

   Please allow (1) business day for processing. 

   For same day service requests, DO NOT submit this form. Please contact Customer Service at 407-571-8044, before 12:00pm noon, to handle your request.

7. Account Number:*
9. Account Holder Name:*
10. Termination Date:*
    Termination Date:
12. Last 4 of Driver's License Number:*
13. Phone Number:*
15. Service Address:*
17. Forwarding Address:*
19. City:*
20. State:*
21. Zip Code:*

23. I certify that I am the current account holder of the abovementioned account. I understand that I am requesting services to be discontinued as of the Termination Date mentioned above and will be billed through that date. Any balances due will be my responsibility and shall be paid by the due date to avoid any collection activity.

25. Acknowledgement:*

    1. I certify and understand the information above.
27. Signature:*
28. Date:*
    Date:
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field