If you are moving, use this online request form to cancel your utility service. To ensure prompt processing, please be sure to inform us at least five (5) business days in advance of your move. You will receive an email with a confirmation number. Required fields are marked with an asterisk (*) Account Holder Information Company Name (Commercial account only) First Name & initial * Last Name * Phone Number * Alternate Phone Number Date of birth Email Email Email * Confirm email * Service (Civic) Address Civic Number * Unit / Apartment Street Name and Type * City / Community * Province * Postal Code * Forwarding Address: Civic Number Unit / Apartment Street Name and Type City / Community Province Postal Code Cancellation Date Preferred date for cancellation of service * Information Information I agree Submit * In submitting this form the customer acknowledges and agrees to the following conditions: The applicant agrees to take and pay for water, wastewater and stormwater service from Halifax Water in accordance with this application and to accept and pay for such services according to the rates, rules and regulations of Halifax Water. Access and Privacy In accordance with Section 485 of the Municipal Government Act (MGA), the personal information collected on this form will only be used by Halifax Water staff for purposes relating to the provision of water and/or wastewater/stormwater services. If you have any questions about the collection and use of this personal information, please contact Customer Service at 902.490.4820 or CustomerService@halifaxwater.ca. What code is in the image? * Enter the characters shown in the image.