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Copyright ©2003
Madison Water &
Wastewater Board
101 Ray Sanderson Drive
Madison, AL 35758
(256)772-0253
Site Created & Developed by Belzon, Inc. http://www.belzon.com
contact.gif - Name Change
Name Change

This form is to request and authorize the Board to change the name on your account. (This also changes the name for return of Deposit).

If you desire to fill out this form by hand and submit it to us via email or fax, click here to download a printable version of this form.
Email:
From The Name Of:
To:
Reason For Change:
Service Address Of Deposit:
Digital Signature:
Date: ,

If you have any questions or comments concerning service please call us at (256)772-0253 EXT 100 OR click here to contact us. (E-mail address jshepard@madisonwaterboard.org).
 
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