Tenant Change Form

2. Account Number

3. Service Address*

4. Move In / Out Date*
   Move In / Out Date

6. Owner Name*

8. As owner of the above listed property, I am informing you that:*

   1. My tenant moved in.
   2. My tenant moved out.
   3. I've added a Property Manager.
   4. I've removed a Property Manager.

9. Bill to:

   1. Owner
   2. Property Manager

11. Please choose one of the following Off Cycle Billing options for your tenant move in/out:

    1. Request the City of Bremerton to read the meter for a fee of $23
    2. Meter read declined. Send next bill to Owner/Property Management. Will handle move in/out. No fee.

13. Note: As a courtesy to the owner, only the owner may request to have the billing sent to the tenant. If the tenant vacates leaving outstanding charges, the City will not go to collections to get payment from the tenant. The unpaid charges stay with the property and therefore become the responsibility of the owner.
    
    There will be a $5 fee to add a tenant.

15. Electronic Signature*

    1. By clicking this box you are signing this form electronically

16. Owner Name*

    Please type name.

17. Date*
    Date

21. Section A: TENANT INFORMATION FOR BILLING

23. First Name

24. Last Name

25. Cell Phone

26. 2nd Phone

28. Co-First Name

29. Co-Last Name

30. Co-Cell Phone

31. Co-2nd Phone

33. Mailing Address (Service Address/PO Box)

35. City

36. State

37. Zip

39. Email Address

40. Bill Type

    1. E-Bill Only

    1. Both

    Select "Both" to receive a paper and electronic bill

44. Section B: AGENT/PROPERTY MANAGEMENT/POA

46. First Name

47. Last Name

48. Phone Number

50. Mailing Address

52. City

53. State

54. Zip

56. Email Address

57. Agent Name

61. Section C: OWNER INFORMATION FOR OWNER ACCOUNT

63. First Name*

64. Last Name*

65. Phone Number*

67. Mailing Address*

69. City*

70. State*

71. Zip*

73. Email Address

Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field