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City of Lloydminster Utility Account

Name Change Request

Effective Date

Service Address

Utility Account Number

Contact Name

Contact Phone Number

Contact Email Address

Phone Number of Main Contact

Email Address of Main Contact

Signature 1

Clear

Please note, if a new party is responsible for the bill, both signatures are required. If the new name on the utility account is not on the property taxes, a connection form is required and will be subject to a $250 deposit. (Does not include name changes due to a legal name change)

Your personal information is being collected under the authority of section 25 of the Local Authority Freedom of Information and Protection of Privacy Act. This information will only be used to administer the program/activity it was collected for . If you have any questions about the collection please contact the Office of the City Clerk at 780-875-6184 or email cityclerk@lloydminster.ca

Forms

City of Lloydminster Utility Account

Name Change Request