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2. Moving Out of Schiller Park
4. Moving Out Date
   Moving Out Date
6. First Name Of Person Moving Out
7. Last Name Of Person Moving Out
9. Are you the Owner of this property or a Renter?

   1. Owner

   1. Renter
11. First Name of Landlord or New Property Owner
12. Last Name of Landlord or New Property Owner
14. Service Address
16. City
17. State
18. Zip Code
20. Account Number
22. Moving/Closing Date
    Moving/Closing Date
23. Requested Date of Final Read
    Requested Date of Final Read
25. Forwarding Address
27. City
28. State
29. Zip Code
31. Phone Number
32. Fax Number
34. Email Address
36. * Your final bill will be sent to the forwarding address
40. Deposit Information

    Upon Completion of your Final Water Bill Payment and THIS Application, you will be refunded your deposit which is $150 for residential and $300 for commercial. 

42. Refund Information
44. Forwarding Address (For the Check)
46. City
47. State
48. Zip Code
50. Phone Number
51. Fax Number
53. Email Address
57. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
59. Electronic Signature
60. Date
    Date

    Date
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field