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2. The Village of Channahon offers residents the option to request temporary suspension of refuse services for a minimum of 4 consecutive weeks (1 month) or longer when the home is not occupied. Please note that it is the property owner's responsibility to notify the Village of reinstatement of refuse services if needed prior to the suspension end date listed below.
4. Name on Account*
5. Email Address*
7. Service Address*
9. Phone Number*
11. Suspension Start Date*
    Suspension Start Date
12. Suspension End Date*
    Suspension End Date
16. PLEASE NOTE:
    Water service accounts will continue to receive a bill on a monthly basis, minus refuse charges, during the period of temporary suspension. If at any time the Village determines there is substantial water usage indicating that the home is occupied, the residences' refuse service will be reinstated immediately. Residents are encouraged to set up a temporary forwarding address during the suspension of service.
18. Forwarding address during temporary suspension of refuse service:
20. Address
22. City
23. State
24. Zip Code
28. Because the home will not be occupied, I hereby request the Village of Channahon put my account on temporary suspension for refuse services in accordance with the dates provided above. I understand it is my responsibility to contact/notify the Village of any changes related to the requested temporary suspension including returning early, extended stay, unexpected delays, etc. The Village must be notified no later than the Wednesday prior to your reinstatement of service in order to guarantee refuse service.
30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
33. Date*
    Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field