Get LA Application for Service Disconnection 2005

Application for Service Disconnection Customer Service 318 251-8675 APPLICANT INFORMATION Customer Name Rental Property No Yes Service Address Telephone No. Date Requested Mailing Address City State ZIP FORWARDING INFORMATION Street Address P. O. Box Other Phone No STUDENT INFORMATION Parent s Address OFFICE USE ONLY Date Received Received By Account No Service Charge Deposit Amount Date Scheduled Deposit Date Date Completed Receipt No. Completed By/Time ID Type Drivers License Other METER INFORMATION OFFICE USE ONLY Water Meter 1 Electric Meter 1 Serial No Reading Installed Serial No. FORM INSTRUCTIONS Completed applications must be delivered by the responsible party to the City of Ruston Customer Service Center located on the south side of Ruston City Hall at 401 North Trenton Ave. A Customer Service Representative will review the application and determine deposit refund requirements. Application for Service Disconnection Customer Service 318 251-8675 APPLICANT INFORMATION Customer Name Rental Property No Yes Service Address Telephone No* Date Requested Mailing Address City State ZIP FORWARDING INFORMATION Street Address P. O. Box Other Phone No STUDENT INFORMATION Parent s Address OFFICE USE ONLY Date Received Received By Account No Service Charge Deposit Amount Date Scheduled Deposit Date Date Completed Receipt No* Completed By/Time ID Type Drivers License Other METER INFORMATION OFFICE USE ONLY Water Meter 1 Electric Meter 1 Serial No Reading Installed Serial No* FORM INSTRUCTIONS Completed applications must be delivered by the responsible party to the City of Ruston Customer Service Center located on the south side of Ruston City Hall at 401 North Trenton Ave. A Customer Service Representative will review the application and determine deposit refund requirements. O. Box Other Phone No STUDENT INFORMATION Parent s Address OFFICE USE ONLY Date Received Received By Account No Service Charge Deposit Amount Date Scheduled Deposit Date Date Completed Receipt No* Completed By/Time ID Type Drivers License Other METER INFORMATION OFFICE USE ONLY Water Meter 1 Electric Meter 1 Serial No Reading Installed Serial No* FORM INSTRUCTIONS Completed applications must be delivered by the responsible party to the City of Ruston Customer Service Center located on the south side of Ruston City Hall at 401 North Trenton Ave. A Customer Service Representative will review the application and determine deposit refund requirements. .