Forfeit Tap Authorization Form

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

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. *
Signature: *
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.