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2. The City of Pasadena Water Billing Department is in the process of updating and verifying information of the utility billing records. Often, phone numbers and email addresses change over time, and the City would like your help by providing the following information to keep your account current.
6. Select a Choice
   -- Select One --Change Phone NumberChange Email Address
10. This information will be used for verification purpose.
12. Account Number (if known)
14. Name*
16. Property Address*
    Service Address
18. New or Forwarding Address:
20. New or Forwarding City, State & Zip:
24. This information will be used for updating utility records:
26. Home Phone
28. Cell Phone
30. Email*
32. Comments:
34. 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.

    1. I agree.
36. Electronic Signature*
37. Date*
    Date
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field