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2. 

3. 
   
   
   Complete the information below if you are a landlord and you want to request a transfer of utility services for your rental property.

5. Your Name:*
7. Address of your rental property:*

   Remember to include the unit number, if there is one.

9. Tenant's Name:*
11. CONTACT INFORMATION
13. Your mailing address:*
15. City:*
16. State:*
17. Zip Code:*
19. Phone Number:*
20. Email Address:*
22. WHAT WOULD YOU LIKE TO DO?*

    1. The water is currently turned OFF. My tenant has moved out and I want the water turned ON.
    2. The water is currently turned on. My tenant has moved out and needs a final bill.

    Please be aware that you will receive the monthly bills for this property while the water is turned on and the account is in your name.

24. When did the tenant leave the property?*
    When did the tenant leave the property?
26. UTILITY TERMS AND AGREEMENT

    As the owner of this service address, I understand that I am liable for all outstanding utility charges billed to the property, which includes any final tenant balance that is not covered by the tenant's deposit.
    
    I also understand that delinquent balances may be certified to the property taxes if they remain unpaid.

    Submission of this form is my acknowledgement of the terms above.

28. Additional Comments
Leave This Blank:


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

    This field is not part of the form submission.

32. Submit Submit and Print

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