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Utility Billing Department Change of Mailing Address

City of Blythe
Utility Billing Department
CHANGE OF MAILING ADDRESS
235 N Broadway Blythe, 92225
760-922-6161 Ext 1233 or 1234
CUSTOMER SERVICE INFORMATION
Last Four Digits of SSN*
^{This information is used internally to verify the identity of the Account Holder/Customer}
Customer Name*
Service Address*
Service Account #:*
Contact Phone #
Contact Phone # Type
Old Mailing Address*
(if different from Service Address)
New Mailing Address*
Customer Signature*
‎A signature is required to process your request. By entering your valid email address in the box below you are signing this form and confirming that the above information is correct.
Date*
Date
‎
FOR OFFICE USE ONLY

^{Completed By}
^{Date Completed}

FOR OFFICE USE ONLY

^{Completed By}	^{Date Completed}

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