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Change of Mailing Address

2. 

3. CHANGE OF MAILING ADDRESS

5. CUSTOMER NAME*

7. ACCOUNT NUMBER*

8. Effective Date*
   Effective Date

10. EMAIL ADDRESS

12. CURRENT MAILING ADDRESS:

14. Street Address*

16. City, State, Zip*

18. NEW MAILING ADDRESS:

20. New Mailing Street Address*

22. New City, State, Zip*

24. NEW/CURRENT PHONE NUMBER*

26. PLEASE NOTE:
    The Post Office will not forward your water bill. You must change your address with the City of West Melbourne Utilities Department.

    The Post Office will not forward your water bill. You must change your address with the City of West Melbourne Utilities Department.

28. By signing below, I understand that anytime my mailing address changes, I need to notify the Utilities Department immediately.

    By signing below, I understand that anytime my mailing address changes, I need to notify the Utilities Department immediately.

30. Signature*

    Type name

31. Today's Date*
    Today's Date

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field