Form

TOWN OF ERICKSON
PO Box 40, Erickson, Mb R0J 0P0
Utility Account Change Request
Please complete the form below to have your Town of Erickson Utility Account updated. All required information can be found on your previous bill. If you are requesting a new Utility Account Connection, please ensure you provide the Service Address, and previous owner/landlord's name. If you have any questions, you can contact the Municipal Office by email at ericksonadmin@mts.net or by phone at 204-636-2431. Thank you for keeping your account up to date.
Name*
Mailing Address*
City/Town, Province*
Postal Code*
Country*
Today's Date*
- Day - Month Year
at
/ Hour Minutes
Phone #*
Email Address*
Account Information
Reason for Change*

Change of Ownership New Tenant Tenant Moving Out (Revert to Owner) Disconnection of Service Reconnection of Service Meter Change Other (Please explain in the Notes section below.)
Change Effective*
- Day - Month Year
at
/ Hour Minutes
Account #*
Service Address*
In the notes section below, please provide us with the reason for change if you chose "Other" above. Please insert any other comments/concerns you may have regarding the change, as well as the Name and Address (if known/applicable) of the new Utility Account Holder.
Notes:
Should be Empty:

Utility Account Change Request