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2. PLEASE SUBMIT NO LATER THAN 3 BUSINESS DAYS PRIOR TO MOVING IN/OUT

   Requests may be submitted in advance but no later than 72 hours prior to move in/out date. Requests received less than 72 hours may receive an estimate final bill. Failure to notify our office of request cancellations may result in an administrative fee applied to the utility account.

   ATTENTION LANDLORDS: As the property owner, it is your responsibility to pay any outstanding balance due and owed to for Village Service Accounts if the tenant neglects to pay. 

4. Today's Date:
   Today's Date:

   Today's Date:
6. First Name of person requesting final read*
7. Last Name of person requesting final read*
9. Montgomery Service Address*
11. Phone Number*
12. Email*
14. Select One
    -- Select One --OwnerRenterManagement Company
18. Please Complete A Separate Request For Each Transfer
20. Renter(s)*
    -- Select One --Moving InMoving Out
21. Date Rental Agreement Begins/Ends*
    Date Rental Agreement Begins/Ends
23. Renter(s) First Name*
24. Renter(s) Last Name*
26. Renter(s) Phone Number*
28. Renter(s) Forwarding Address (if moving out)*
30. Address2
32. City
33. State
34. Zip
38. Owner(s) First Name*
39. Owner(s) Last Name*
41. Owner(s) Phone Number*
43. Owner's Billing Address 1 - if known
45. Address2
47. City
48. State
49. Zip
51. Terms of Agreement

    By enrolling in a Village Service Account, I hereby confirm that I understand and agree to the terms and conditions as set out in this application and in the Village of Montgomery Code of Ordinances, as may be amended from time to time. I understand and agree to pay all charges for services rendered as a result of this request. I understand and agree that failure to pay any amount due to the Village of Montgomery can result in discontinuation of services until such time as payment has been received, as well as any other penalties as may be set forth in the Village of Montgomery Code of Ordinances, including, but not limited to, Section 2-10.

55. Village of Montgomery Use Only Do Not Fill Out Info Below
57. Work Order Date
    Work Order Date
58. Read
60. Account Number
61. Completed By
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field