TOWN OF ERICKSON
PO Box 40, Erickson, Mb R0J 0P0
Utility Account Change Request
Please complete the form below to have your Town of Erickson Utility Account updated. All required information can be found on your previous bill. If you are requesting a new Utility Account Connection, please ensure you provide the Service Address, and previous owner/landlord's name. If you have any questions, you can contact the Municipal Office by email at ericksonadmin@mts.net or by phone at 204-636-2431. Thank you for keeping your account up to date.
Name
*
Mailing Address
*
City/Town, Province
*
Postal Code
*
Country
*
Today's Date
*
-
Day
-
Month
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Phone #
*
Email Address
*
Account Information
Reason for Change
*
Change of Ownership
New Tenant
Tenant Moving Out (Revert to Owner)
Disconnection of Service
Reconnection of Service
Meter Change
Other (Please explain in the Notes section below.)
Change Effective
*
-
Day
-
Month
Year
Date Picker Icon
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Account #
*
Service Address
*
In the notes section below, please provide us with the reason for change if you chose "Other" above. Please insert any other comments/concerns you may have regarding the change, as well as the Name and Address (if known/applicable) of the new Utility Account Holder.
Notes:
Should be Empty: