Name* First Last Customer Number*Phone*Email* Enter Email Confirm Email Current Address* Street Address Address Line 2 City ZIP Code Date to Disconnect* Date Format: MM slash DD slash YYYY New Service Address* Street Address Address Line 2 City ZIP Code Date to Activate Service* Date Format: MM slash DD slash YYYY Last 4 Digits of SSN**There will be a $25 transfer fee added to the account and will be shown on your first bill at your new address.*If you are an auto credit/debit card draft customer, your draft information will NOT transfer. You will need to re-enroll with your new account information. Contact customer service at 251-626-2628 for your new account information.*A final bill will be generated for the account that is being closed and forwarded to the new mailing address provided in the form above.*If you are enrolled in the auto bank draft program, the final that you receive on this account will need to be manually paid, as the draft stops when the service is disconnected.VerificationTo protect our site and your information against spam bots and to let us know that you are a real human, we have added an extra security measure of verification. Please enter the numbers in the picture above.NameThis field is for validation purposes and should be left unchanged.