Moving In/Out Form

Moving in/out form for Fridley Utility Billing
Your Name*
Your Phone Number*

Area Code Phone Number
Are you the...?*

BuyerSellerRenter - No need to complete this form.
Will you be...?*

Moving InMoving Out

Service Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Closing Date*

MonthDay Year
New Occupant Name*
Billing Address (if different from service address)

Street Address

Street Address Line 2

City State

Zip Code
# of people residing at new address*
Contact E-mail*

Service Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Closing Date

MonthDay Year
Forwarding Address for final bill

Street Address

Street Address Line 2

City State

Zip Code
Contact E-mail
Name of New Occupant
Should be Empty: