CBM Disconnected/Retirement Request

Please use this form to request a disconnect and/or retirement of all Coal Bed Methane facilities and/or power lines serving your locations.

CBM Disconnect/Retirement Request

The member has requested to disconnect and/or retire all facilities and/or powerlines serving the locations identified below.
Requested By:(required)
Company Name:(required)
Phone Number:(required)
Signature:(required)
Confirmation Letter Received
yes no
Date:(required)
Meter Number 1:(required)
Service Location 1:(required)
Account Number 1:(required)
Work Order Number 1:(required)
Service Order Number 1:(required)
Payoff Amount 1:(required)
Meter Number 2:
Service Location 2:
Account Number 2:
Work Order Number 2:
Service Order Number 2:
Payoff Amount 2:
Meter Number 3:
Service Location 3:
Account Number 3:
Work Order Number 3:
Service Order Number 3:
Payoff Amount 3:
Meter Number 4:
Service Location 4:
Account Number 4:
Work Order Number 4:
Service Order Number 4:
Payoff Amount 4:
Please Verify