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...?

Other
Will you be...?

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: