Moving In/Out Form

Moving in/out form for Fridley Utility Billing
Please note: If you are unable to fill out this form, please email web-Info@fridleymn.gov and the City of Fridley will provide assistance.
Your Name*
Your Phone Number*

Area CodePhone Number
Are you the...?*

BuyerSellerRenter - No need to complete this form.Other
Will you be...?*

Moving InMoving Out

Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Closing Date*

MonthDayYear
New Occupant Name*
Billing Address (if different from service address)

Street Address

Street Address Line 2

CityState

Zip Code
# of people residing at new address*
Contact E-mail*

Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Closing Date

MonthDayYear
Forwarding Address for final bill

Street Address

Street Address Line 2

CityState

Zip Code
Contact E-mail
Name of New Occupant
Please verify that you are human*
Should be Empty: