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Utility Account Open/Close and Transfer Request

Leave This Blank:

Please fill in all questions related to your rental unit. If a section does not apply to you, please answer with N/A. ***Please note: owner occupied properties are not eligible for online utility transfer requests. Please contact Customer Service at 302-366-7085, select option 6, for further assistance.

CURRENT SERVICE ADDRESS INFORMATION

Name:*

Account Number or Property Address (If this does not apply to you, please enter N/A):*

Date of Move Out (If this does not apply to you, please enter N/A):*

Forwarding Address (If this does not apply to you, please enter N/A):*

NEW SERVICE ADDRESS INFORMATION

Account Number or Property Address:*

Date of Move In or Service Responsibility Date:*

Billing Address:*

CONTACT INFORMATION

Name:*

Telephone Number:*

Alternate Telephone Number:*

E-mail Address:*

Please mark you preferred method of contact.*

	Telephone
	Alternate Telephone

E-mail

FOR MOVE-IN APPLICANTS ONLY
* Please submit this form with a copy of your state issued I.D. and social security card. A City of Newark Customer Service representative will contact you for payment of the security deposit, lease or Landlord Occupancy Certification Form, and perform a confidential verification.

***Please be advised that water utility services are only transferable via lien certificates for homeowners and cannot be transferred to tenants.

BELOW IS FOR OFFICE USE ONLY

Identification verified by:

Form of I.D.:

Date:

* indicates required fields.