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BIXBY WATER DEPARTMENT (City of Bixby)

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BIXBY WATER DEPARTMENT
116 W. Needles
Bixby, OK 74008
(918) 366-4430 (918) 366-6373 FAX
NAME: _
Pleaseturn off my serviceat:
__________ ------------------~------on----------~20
Old ServiceAddress Zip code (Date)
Turnon myserviceat:
~~~--~------------------~-~--on--_=~-----20
NewServiceAddress Zip code (Date)
Mailing Address: (If different than service address)
Signature
Date
Home/CellPhone
#:. _
Alternative
# _
Last four of Social Security
# _
For Office use only:
OldAccountNumber _
Wk Order _
NewAccountNumber _
Wk Order
-----
Comments: _
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BIXBY WATER DEPARTMENT (City of Bixby)

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Completed 10 June 2021

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