Required fields are marked with asterisks (*)

Change of Account Information

Names of Owners

Tax Roll Number

Utility Account Number

Municipal Property Address

Email Address

Phone Number

Preferred Method of Contact

Phone

New Address

New Mailing Address

City/Town

Province/State

Postal/Zip Code

Effective Date

Agreement

I hereby declare that I am the registered owner of the above noted property. I authorize the Township of Springwater to make the above change to my mailing address.

Signature

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