Customer/Service ID: Stop Service Date: First Name: Middle Initial:  Last Name:  Old Address:  City:  State:  Arkansas Oklahoma Zip: Social Security Number: Spouse/Co-applicant Name: Spouse/Co-applicant SSN: Status: Married Single Service Address cannot be a P.O. Box. Service Address:  City:  State:  Arkansas Oklahoma Zip: Home Phone: E-mail: Verify E-mail: Mailing Address: City: State: Arkansas Oklahoma Zip: Is service currently ON for the new location? Yes No Unknown AOG will call to confirm schedule date/time if you select No. Start Service Date: Requested By: Note: If you have a security deposit it will be credited on your final bill

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