Account Change Request

Please select a reason for change: (A Government-issued photo ID is required for verification purposes.)
- Power of Attorney (Copy of POA documents are required)
- Adding/Removing of Account Holder
- Updating Account Information
- Legal Name Change/Marriage/Divorce (Legal Documents Required)
- Death (Death Certificate or Executor/Executrix Documents Required)
Account Number*
Date*
MM slash DD slash YYYY
Account Holder
First Last
Drivers License
Primary Secondary
Service Address
Street Address Address Line 2 City State ZIP Code
Mailing Address
Street Address Address Line 2 City State ZIP Code
Date of Birth
MM slash DD slash YYYY
Email*
Primary
Telephone*
Primary
Account Information*
- Adding Account Information
- Removing Account Information

New Account Holder Information: (If Applicable)
Name on Account
First Last
Mailing Address
Street Address Address Line 2 City State ZIP Code
Driver’s License/State ID Number:
State Issued
Photo ID Upload*
Max. file size: 50 MB.
Please upload a state or federal photo ID.
Date of Birth
MM slash DD slash YYYY
Email Address
Phone Number
If there is existing E-Bill information on the account, do you want it removed?*
- Yes
- No
Would you like to set up E-Bill with a new E-mail address*
- Yes
- No
Add E-Bill to E-Mail
If there is existing Autopay information on the account, do you want it removed?*
- Yes
- No
(If yes, please complete a new autopay form. A voided check will be required.)
If there is an existing Customer Portal Account, do you want it removed?*
- Yes
- No

New Account Holder Information: (If Applicable)