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Transfer Residential Utility Service
Current Account Info:
Date to Disconnect Services
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Name
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Last 4 # of Social Security Number
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Current Service Address
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Phone Number
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Email Address
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New Address Info:
Date to Start New Services
*
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Preferred Service Connection Time:
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Morning
Afternoon
New Service Address
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By entering my full name and clicking ‘Submit’ below, I am providing my electronic signature and verifying that the information I have provided on this form is true and correct, and I am authorized to initiate new water service for the address listed on this application.
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Date signed
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