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DPW: Change of Mailing Address

2. 

3. Water Department
   City of Taylor 23555 Goddard Taylor, MI 48180

   City of Taylor 23555 Goddard Taylor, MI 48180

7. Water Account Number*

8. Water Account Address*

10. New Mailing Address

12. First Name*

13. Last Name*

14. Phone Number*

15. Email Address*

17. Address*

19. City*

20. State*

21. Zip Code*

23. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. Please review the City's website privacy policy.

    1. I agree.
25. Electronic Signature*

26. Date*
    Date

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28. Submit Submit and Print

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