Utility Meter Custody Transfer Form

Utility Meter Custody Transfer Form
Complete this form to document the transfer of responsibility for a utility meter. Please ensure all details are accurate to facilitate a smooth handover.
Meter Serial Number
Meter Type
Meter Location/Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Meter Reading
Date of Transfer
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Transferor (Current Responsible Party) Name
First NameLast Name
Transferor Contact Email
example@example.com
Transferee (New Responsible Party) Name
First NameLast Name
Transferee Contact Email
example@example.com
Additional Notes (optional)
Should be Empty: