2. Change of Ownership/ Change of Mailing Address
4. Date:
5. Utility Account Number:
6. Additional Utility Account Numbers:
   (if any)
8. Block:
9. Lot:
10. Qualifier:
12. Property/Service Address:
14. CURRENT name on the account:
16. Reason for Change?

    1. New Owner
    2. Correction of Name/Spelling
    3. Correction of Address
    4. Correction of Phone Number
18. If you are a new owner, what date are you a new owner as of?
20. NEW name on the account:
    If company owned, must include company and contact name.
22. Address
24. City
25. State
26. Zip Code
28. Phone Number:
29. Email Address:
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field