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2. Processing Time
   Please allow a minimum of 5 business days to process.
4. Service Address*
6. Type of Change*

   1. New Billing Address
   2. New Name on Account
   3. Other (Explain in the Change Request Details)
8. Details of Change Request*
10. Account Number*
12. By submitting a phone number and an email address, the City can notify you quickly ion case of an emergency or problem at your home or in your neighborhood.
14. Phone Number*
15. Email Address*
17. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
19. Electronic Signature*
20. Date*
    Date
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field