Village of Lisle Form

Water and Sewer Account Change Request

2. I. SERVICE ADDRESS INFORMATION

4. Closing Date*
   Closing Date

   Please enter your closing date or lease agreement start or end date. 48 hours notice is required for any service change request.

6. Address*

   e.g. 100

7. Street*

   e.g. Main St

8. Requester Email*

   e.g. johndoe@mydomain.com

10. II. CUSTOMER INFORMATION

12. First Name*

13. Last Name*

15. Phone Number

    e.g. 000-000-0000

17. Moving In/Moving Out?*
    -- Select One --Current Customer (Moving Out)New Customer (Moving In)

19. If moving out, please enter the current utility billing account number and the forwarding address for the final bill in Section III. If moving in, skip to Section IV.

21. III. MOVING OUT

23. Utility Billing Account Number

25. Forwarding Address

26. Street

27. City

29. State

30. Zip Code

32. IV. MOVING IN

34. If renting, please provide landlord information:

36. Landlord Name

37. Landlord Phone

39. Landlord Address

    e.g. 100 Main Street, City, State, Zip

41. V. ADDITIONAL NOTES AND COMMENTS

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field