Date of Request (mm/dd/yyyy)*

Effective Date (mm/dd/yyyy)*

Utility Account Numbers*

Service Address*

Only the Account Holder is authorized to make changes to an account with a valid driver's license. A copy of a valid driver's license must accompany this form to make any changes.

Type of Change*

Lock Meter - I understand my deposit will be held. There will be a minimum base charge for water, sewer and sanitation billed monthly. There will be a $15.00 charge to the locked meter. Unlock Meter - I understand my deposit will be held. There will be a charge of $15.00 to unlock the meter.

Finalize Account - I understand there is a $15.00 administrative charge to finalize the account. I have provided my forwarding address in the space that follows. Other (name change/forwarding address/change mailing address)

If you checked Other, please enter the updated information here (name change, forwarding address, change mailing address, etc.)

Property owners will continue to be responsible for payment of base charges for water, sewer and sanitation service until such time as the property is occupied and the account is assumed by a new customer. Requests to lock meters will normally take 3-5 business days. However, due to extenuating circumstances such as unusually high volume, bad weather, etc., the actual time may be longer.

Name

Type of Account*

Owner

Tenant

________________________________________________
Account Holder Signature

Next Steps:

1. Print the form out
2. Sign the form
3. Take to the Cashier/Utility Billing Department located at City Hall
4. Please remember to bring your driver's license