Residential Account Change Request Form

2. Today's Date*
   Today's Date
3. Service Address *
   **City of Snohomish Addresses Only
4. Account Number
6. Email*
8. Choose one of the following:*

   1. I'm moving out (renter) - go to Part A
   2. I'm moving in (renter) - go to Part B
   3. I sold my house (owner) - go to Part C
   4. I purchased a house (new owner) - go to Part D
   5. I would like to change my name/address - go to Part E
   6. I would like to sign up for e-bills (go paperless):
12. Part A - I'm moving out (renter)
14. Move Out Date
    Move Out Date
16. First Name
17. Last Name
19. Forwarding Address
21. Forwarding Address
23. City
24. State
25. Zip
27. Phone Number
31. Part B - I'm moving in (renter)
33. Move In Date
    Move In Date
35. First Name
36. Last Name
38. Mailing Address
40. City
41. State
42. Zip
44. Phone Number
48. Part C - I sold my house (owner)
50. Closing Date
    Closing Date
52. First Name
53. Last Name
55. Forwarding Address
57. Forwarding Address
59. City
60. State
61. Zip
63. Phone Number
67. Part D - I purchased a house (new owner)
69. Closing Date
    Closing Date
71. First Name
72. Last Name
74. Mailing Address
76. City
77. State
78. Zip
80. Phone Number
84. Part E - I would like to change my name/address
86. First Name
87. Last Name
89. Mailing Address
91. Mailing Address
93. City
94. State
95. Zip
97. Phone Number
101. How would you like to receive your bills?
     -- Select One --Paper Billse-bills (make sure email address is provided)Both paper and e-bills

     Choose paper, e-bills, or both
103. Further Comments
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit

* indicates a required field