If you wish to apply for deregistration for supplying drinking water can do filling out the form below.

Once we receive the request and proceeded downward issued a final invoice residual consumption over the previous billing.

Number of contract

Name

NIF/CIF

Telèfon de contacte

Place of supply

Name

Title of representation

Contact Telephone

No. Counter

Meter reading

The undersigned request the rescission of the policy subscription signed by the Service Municipal Water Binissalem's home indicated above, knowing that this Rescission the payment policy will only be effective once the outage occurred or change of ownership of it, and having all outstanding bills paid to date of cancellation.

Change of holder
Voluntary
Others

Fm. (The applicant)

(Photocopy of ID as authorized signature)

Firmat (El titular)

(Adjuntar signed authorization holder)

fm. (concesionari)

Comments

He llegit i accepto el text de protecció de dades