Please complete and submit the following form to cancel your automatic utilities payments. Account Number Owner's Last Name Owner's First Name Property Address Effective Date of Cancellation Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 Email Address Primary Phone Number Signature By checking this box and clicking submit, I confirm I am authorized to sign for this application. Name of Person Applicant (if different from owner name) Privacy StatementThe personal information on this form is collected under the Freedom of Information and Protection of Privacy Act and will be used in order to process this form. See the Town of Olds Privacy Policy for more information. Leave this field blank