2. Disconnection Request for Services with the City of Pierre

   The date for services to end must be today or later. For prior dates, please contact City Hall at 605.773.7407 or utilities@ci.pierre.sd.us.

4. Date*
   Date

   Today's date

5. Date Services End*
   Date Services End

   Date you want services to end

7. Name*
8. Landlord
10. Email Address*
12. Service Address*
13. Phone Number*
15. Forwarding Address*

    Enter forwarding address (Street, City, State and Zip Code) for utility deposit refunds and final bills.  

17. Landfill / Recycling Card

    Please initial

    I understand if I fail to return my city-issued Landfill  / Recycling card  by the date of service disconnection, I will be charged a $25 fee.

18. Deposit Refunds

    Please initial

    I understand checks are not processed for less than $5; refunds less than $5 are transferred to Pierre Area Referral Service.

20. The above listed customer requests disconnection of City of Pierre utility services at the location and date listed above. The customer is responsible for all bills and charges at this address until the requested date  listed above.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field