Fillable Change of Billing Address Form (City of West Memphis)

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Change of Billing Address Form (City of West Memphis)

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WMUC, CBA Form, Revised 8/12
Change of Billing Address Form
Name: _____________________________________________________________________
Address: ___________________________________________________________________
Account Number: ____________________ Phone: ________________________________
ACCOUNT INFORMATION (PLEASE PRINT)
NEW BILLING INFORMATION (PLEASE PRINT)
Mail To: _____________________________________________________________________
Street: _____________________________________________________________________
City: ____________________ State: ________________________Zip Code: _____________
Signature: ______________________________________________ Date: ________________
Email:________________________________________________________________________
In accordance with WMUC Policy Article 8.4: Failure to receive a bill shall not release a customer from
payment obligations.
FOR OFFICE USE ONLY
Received By: __________________ Date: _____________
Completed By: _______________ _ Date: ____________
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Change of Billing Address Form (City of West Memphis)

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Completed 17 July 2020

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