Trash & Sewer Account Change Form Your Name Your Email Service Street Address Service Billing Address Account Number - Customer Number I would like to change: Name on accountPhone numberBilling/Forwarding addressEmail addressTrash bin sizeBilling cyclePlace account on hold*Terminate service**Reinstate sewer serviceReinstate trash and/or sewer and trash service*** Effective date of change *Trash bin must be available for pickup in order to place your account on hold. Accounts that are on year in advance billing CANNOT be placed on hold. **A $25.00 per bin charge will be applied to final accounts if trash bin is not recovered upon service termination. ***A $7.50 fee will be charged to reinstate sewer service. A $32.50 fee will be charged to reinstate trash only, or sewer and trash service. If you are changing the name or phone number on your account, what is the updated name and/or phone number? Name Phone Number If you are changing your mailing address, what is the new address? How would you prefer to receive invoices? MailEmail*Both *Please enter the email address the City should use for your invoice. If you are reinstating your service, what size of bin would you like? 65 gallon95 gallon If you are terminating, what is the reason for termination? Effective date of termination: If you would like to change your trash bin size, what size of bin would you like?* 65 gallon95 gallon *Please note that a $25 bin exchange fee will be added to your next invoice. If you are changing your billing cycle, what cycle would you like?* Bi-monthlyYear in advance *Please note that regardless of when you request a billing cycle change, the change will only take effect in July/August. Your Message By checking this box, I acknowledge that I will be billed all applicable fees as noted above. I further certify that I am the account holder of the above listed property. I understand that I am financially responsible for the services provided to me by the City of Sierra Vista. I agree to pay my account charges in a timely manner. If it becomes necessary, I agree to pay a 10% penalty fee for delinquent payments and reasonable fees associated with the collection of any past due account. This electronic form is as valid as the original.