Account Name:(Required)Sewer Account Number:(Required)Service Address:(Required)Service Address City, State, Zip Apache Junction, AZ 85119 Apache Junction, AZ 85120 Type of Customer:(Required) Owner Lender Broker Authorized Representative Power of Attorney Reason for Change: Address Change Trustee Sale Change of Name Change of Ownership Other Name of Person Submitting Request:Phone Number:(Required)Mailing Address Street:(Required)Mailing Address City:(Required)Mailing Address State:(Required)Mailing Address Zip:(Required)Email:(Required) Close of Escrow Date (if applicable) MM slash DD slash YYYY For Account Verification: (Last 4 of SSN) or (Date of Birth)(Required)Please upload a supporting document (if applicable).Max. file size: 50 MB.By electronically signing, I am stating that I am the legal owner or have the legal authority over the real property identified above. I/we acknowledge responsibility for all charges up to the date of termination, which shall not precede the legal transfer of ownership.(Required) I agree to the terms and conditions stated above and I understand by checking this box and typing my full name below, this constitutes a legal signature as the owner or legal representative of the above mentioned property.Signature: (Please type your full name.)(Required)
