Please terminate my electric service on:
* Please be advised the electric service will be subject to disconnection as of 8:00 a.m. on the requested termination date.
The requested termination date must be a KEYS' business day.
Customer Name:
KEYS' Account Number:
KEYS' Service Address:
Please send my final bill for electrical service and/or my customer deposit refund to:
Mailing Address:
City: State: Zip Code:
After service is disconnected, I can be reached by phone:     Email:
I ACCEPT - I understand that by checking the box next to the words "I ACCEPT" and typing my name below, I am signing this document electronically.

Customer Signature:   Date:
Drivers License Number:
Form last revised: 04/10/15