Information Update Request

Information Update Form
General Guidelines
- A valid ID is required on the form. Please upload a copy when prompted and attach it to the application.
- To verify Eagle Mountain City has received all required documentation and payment(s), please contact Eagle Mountain City at 801-789-6606. Utility Billing has up to three business days to process the application.
Important*

All information provided as part of this form will be stored by a third-party service provider. If you do not with to provide personal information such as your SSN or ID# on the JotForms site, we require that you provide them in person at the Utility Billing office. To view details regarding the security measures put in place by JotForms, please visit: https://www.jotform.com/security/
OFFICE USE ONLY
Click Next to go to OFFICE USE ONLY fields

OFFICE USE ONLY

Changes will be saved automatically
Reviewed By (Name or Initials):*
Date Reviewed:*

MonthDayYear
Date
Status*

ApprovedDenied
Reason for Denial

Customer Identification

Please provide the information as it CURRENTLY appears on your account.
Customer Name*

First NameLast Name
Utility Account Number
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Service Address*

Street Address Line 2

CityState / Province

Postal / Zip Code

Changes Needed

Please allow up to 2 days from date requested
Please select what changes need to be made*

Name ChangeMailing Address ChangePhone Number ChangeAdding Co-Applicant to AccountRemove Co-ApplicantChange of Property Manager / Property Management CompanyRequest courtesy copy of monthly bill sent to renter "Occupant"Stop sending courtesy copy of monthly bill to renter "Occupant"
Name Change

First NameLast Name
Mailing Address Change

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number Change
Please enter a valid phone number.
Co-Applicant Name*

First NameLast Name
Co-Applicant Social Security Number*
Co-Applicant Driver's License Number*
Issuing State*
Expiration Date*

MonthDayYear
Date
The Co-Applicant agrees to pay all utility service charges and other related fees and charges to the City in full as they become due. The timely payment ot the City of all required fees and charges is a condition for the continued service of all utilities to the property described above. The Co-Applicant hereby agrees to comply fully with all ordinances, rules and regulations in force at the date of this agreement or to be enacted in the future by the City for utility services.

This agreement is executed by the Co-Applicant as property owner or by an authorized agent of the property owner. By accepting the services from utilities furnished by the City under this agreement, the property owner and Co-Applicant agrees to be bound by the terms of this Agreement.
Please upload a Picture ID of the Co-Applicant*

Cancelof
Property Owner Signature*

Clear
Co-Applicant, please sign on the same signature line
Co-Applicant Signature*

Clear
Co-Applicant, please sign on the same signature line
Name of Co-Applicant to Remove*

First NameLast Name
Please Upload Photos of ID for Applicant and Co-Applicant*

Images are limited to 5 MB or smaller.
Cancelof
Signature of Applicant*

Clear
Signature of Co-Applicant*

Clear
Property Manager or Property Management Company Name*
Property Manager/Company Phone*
Please enter a valid phone number.
Property Manager/Company Email*
example@example.com
Property Manager/Company Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner Signature*

Clear
Upload Photo of Property Owner ID*

Cancelof
Should be Empty:

Information Update Form

OFFICE USE ONLY

Customer Identification

Changes Needed