Village of Lisle Form

2. MOVING IN/OUT*
   -- Select One --Current Customer (Moving Out)New Customer (Moving In)
4. EFFECTIVE DATE (Closing date/Lease date)*
   EFFECTIVE DATE (Closing date/Lease date)

   48 hours notice is required for any service change request.

6. 1. SERVICE ADDRESS
8. Address*
   e.g. 100
9. Street*
   e.g. Main St
11. 2. CUSTOMER
13. Select One*

    1. Owner
    2. Tenant
15. First Name(s)*
16. Last Name*
18. Customer Phone Number*

    e.g. 000-000-0000

19. Customer Email*

    e.g. johndoe@mydomain.com

21. 3. CUSTOMERS MOVING OUT - complete this section
23. Utility Billing Account Number

25. SEND FINAL BILL TO:

27. Forwarding Address
28. Street
29. City
31. State
32. Zip Code
34. 4. TENANTS MOVING IN - PROVIDE LANDLORD INFORMATION
36. Landlord Name
37. Landlord Phone
39. Landlord Address
    e.g. 100 Main Street, City, State, Zip
41. 5. 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