Forfeit Tap Authorization Form

Service Address of the tap being forfeited: *

Blue Ridge Rural Water Account Number: *

By forfeiting a tap water service is no longer wanted at this location. This is NOT transfering service to new owner.

Name on the Blue Ridge Rural Water account

First and Last Name *

Email Address: *

Phone Number: *

Please attach a scanned copy of a photo ID of the account holder on record with Blue Ridge Rural Water or the individual who have legal authority to act on behalf of the account holder. *

I understand that I am no longer need water service at this location by forfeiting the service at this location listed above. If I wish to have water service in the future, I will have to pay previous monthly bills in addition to the account set-up, meter, and tap fees at that time. *

I agree

Signature: *

clear

Date: * +

Please click submit and you will be redirected to Blue Ridge Rural Water Company's website.

A copy of the completed forfeit form will be sent to your email provided for your records.

Thank you for your time.