Address Change Request Form

Current Account Information
In order to protect your account we need to verify some information. Please enter in your account information as it appears on your bill.
The LSDC's Privacy and Identity Theft Prevention Policy requires that we confirm the identity of the customer requesting account information. This information is necessary to prevent fraud and will help us expedite your request.

If you do not have an account number please provide the amount of the last sewer bill paid.

If you do not have this information please enter '0' and fill out the remainder of this form and someone from our office will contact you. Submissions lacking this information may take longer to process.
Amount of last Bill Paid*
Account Number*
As it appears on your bill
I do not have my account number
Service Address*
This is the address that is serviced
Last Name or Business Name*
As it appears on your bill
First Name*
As it appears on your bill
Phone Number*

Area CodePhone Number
E-mail*

New Account Information
Enter in the account information that you want to change to.
Change Type*

New Billing NameNew Billing Address
New Last Name or Business Name*
This will be the new last name as it appears on your bill
New First Name*
This will be the new first name as it appears on your bill
New Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Submission*

By checking this box and submitting this form, I acknowledge that I am the Account Holder of the referenced account and am authorized to make changes in the billing address. I am additionally consenting for my email address to be added to the LSDC's online account access system.
Email a copy of this form to myself