Residential Billing Change


This form is used to change current or future-dated billing responsibility at residential rental properties. In order to serve you better, please provide as much detail as possible on this form. Incomplete information may delay processing. To submit past-dated billing responsibility requests, please call our Business Center at 800-714-7777.

Indicates required form fields.

Service address information
Electric
Gas
Both Electric and Gas


Date billing responsibility changes:
Service address:

Apartment:
City:
State:
Zip:

New occupant information
Name:
SS#:
Employer:
Work phone:
Cell/other phone:
 
 
Mailing address (if different than service address)
Address:
Apartment:
City:
State:
Zip:
Former address of new occupant
Address:

Apartment:
City:
State:
Zip:
Spouse/Roommate name:
SS#:
Employer:
Work phone:


Previous occupant information
Name:
SS#:
Forwarding mailing address:
Work phone:
City:
State:

Zip:        

Owner/management company information
Owner name:
SS#/Fed. TIN:
Address:
Apartment:
City:
State:
Zip:
Work phone:
Fax:   
Contact person:
Phone:
E-mail:

Management company:  
SS#/Fed. TIN:
Address:
Apartment:
City:
State:
Zip:
Work phone:
Fax:
E-mail:
Contact person:
Phone:
E-mail:


Meter reading information
Electric  
Meter number:
Meter reading:
Date of meter reading:
Gas
Meter number:
Meter reading:
Date of meter reading:

         

Name of person completing the form:
Completer Email:
Completer Phone:
Form Date: