Garbage/Sanitation & Water Disconnection Request Form

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Please correct the fields below:

Please correct the field(s) marked in red below:

If you have any questions, please contact the Financial Services Division at fsd@roswellgov.com or 770-641-3759. All final statements are sent electronically to your email address.

Please note: A representative will send a confirmation to the email address submitted below after your request has been processed.

*

Account Holder Name:

Service Address:

Did you own or lease this property?

If leased, lease end date:

If leased, landlord name:

If owned, date of sale:

If owned, name of new owner (required):

Your Forwarding Address:

Email (required):

Phone:ext.

*

Signature (Please type your full name in lieu of your signature):

Date:

To receive a copy of your submission, please fill out your email address below and submit.
Email Address