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2. 
3. CHANGE OF MAILING ADDRESS
5. CUSTOMER NAME*
7. ACCOUNT NUMBER*
8. Effective Date*
   Effective Date
10. EMAIL ADDRESS
12. SERVICE ADDRESS*

     West Melbourne, FL. 32904

14. NEW MAILING ADDRESS:
16. New Mailing Street Address*
18. New City, State, Zip*
20. NEW/CURRENT PHONE NUMBER*
22. PLEASE NOTE:
    The Post Office will not forward your water bill. You must change your address with the City of West Melbourne Utilities Department.
24. By signing below, I understand that anytime my mailing address changes, I need to notify the Utilities Department immediately.
26. Signature*
    Type name
27. Today's Date*
    Today's Date
Leave This Blank:


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

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field