[City of Bloomington, Illinois] Application To Stop Services

Application To Stop Services

Full Name / Business Entity

Currently Occupied By

Owner

Tenant

Phone Number

Please Be Aware: There Is No Way To Back Date

Date Requested To End Services

Upload Valid ID of Person Requesting and Residing in Current Address (State Issued Driver’s License, State Issued Photo ID, or a Passport)

Click Here to Upload

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.