Service Disconnect | Nodak Electric Cooperative, Inc

Service Disconnect

Service Type to be Disconnected

Business Name

Contractor Name

First Name

Middle Initial

Last Name

Telephone Number

Account Number

Meter Number

If unknown, enter 0.

Email Address

Service Address

Address where you receive electrical service from Nodak Electric.

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Do you own or rent this property?

Own

Rent

Rental/Leasing Agency

Rental/Leasing Agency Phone Number

Last Date of Occupancy

Last day I am responsible for purchasing electricity.

Forwarding Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Did you work with a Realtor?

Yes

Realtor Company

Realtor Name

Realtor Phone Number

Do you know the name of the new occupant?

Yes

Name of New Occupant

Phone Number of New Occupant

Signature

By signing below, I acknowledge that I am planning to move out of my current residence, thus transferring responsibility for electric service, on the "Last Day of Occupancy" as stated above.

First Name of Signee

Last Name of Signee

Nodak Electric Cooperative

Address

Contact Info

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