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PICKENS COUNTY WATER AND SEWER AUTHORITY Phillip Dean Kris Stancil Director of Utilities Commissioner Chairman DISCONTINUE SERVICE FOR PICKENS COUNTY WATER AND SEWER I would like to stop service on account number Discontinue Service Date Name on Account Address Forwarding Address Phone Number A final bill will be processed for usage up until the date of termination. Termination requests are processed the next available work order day. Our office will keep this form as proof of your request to discontinue service. Please send a copy of your driver’s license with this form. Signature _ Date _ 1266 East Church St.; Ste 117 Jasper, GA 30143 Phone [PHONE REDACTED] Fax [PHONE REDACTED] SIGN