EmailMe Form - City of Neillsville Utilities Change Order

Type of Request *
Move In
Move Out
Billing Name change only
Temporary Mailing Address change
**If moving out, please fill out section with address to send final bill.**
**If adding a temporary mailing address change, please enter the start and stop dates**
Type of Property *
Rental
Purchase/ Sale
Temporary Mailing address change start
MM / DD / YYYY
Temporary Mailing address change stop
MM / DD / YYYY
Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

** If your mailing address is different than the actual address, please use 'Address Line 2' for your mailing address with the actual address on the 'Street Address' line **
Phone *
### - ### - ####
Email
Move In/ Move Out Date *
MM / DD / YYYY
We cannot back date a move out to a previous date. Please enter today's date or a date in the future.
Address to Send Final bill (Required if 'Move Out' is selected)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Comments
Please enter any information you would like us to know. For example, if you are just changing your mailing address for the winter, please provide us with the dates needed.