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Step One

Authorized Utility Account Updates
Property owners may submit this form to update utility account name, billing address, phone number, email, or to authorize account updates to a 3rd party/non-owner.
Updates to utility accounts are only accepted from an owner of the property or an authorized 3rd party. New tenants should contact the property owner to submit the update or authorization.
Utility Account Number
Enter account number found on utility bill xxxxx-xxxxx (leave out preceding zeroes.
Property Address*
Enter property address where utility service is provided.
Apt/Unit/Lot#
Enter if applicable or leave blank
Owner First Name*
Owner Last Name*
Owner Business Name
Enter name of business if applicable
Owner Mailing Address*
Enter the address where the utility bill should be sent or duplicate bill if tenant is responsible for payment.
City*
State*
Zip*
Owner Phone Number*
Owner Alternate Phone Number
Owner Email Address
Billing Preference*
1. Mail Only
2. Email Only
3. Mail & Email
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Step Two

Tenant Information (if applicable)
Complete this section ONLY if utility payment is tenant responsibility
Is there a tenant at this property?
1. Yes
2. No
Is tenant responsible for utility payment?
1. Yes
2. No
Tenant First Name
Tenant Last Name
Tenant Business Name
Enter name of business if applicable
Tenant Billing Address
City
State
Zip
Tenant Phone Number
Tenant Alternate Phone Number
Tenant Email Address
Billing Preference
1. Mail Only
2. Email Only
3. Mail & Email
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Step Three

Authorization for release of utility information
For the purposes of Act 25, Wis. Stat. §196.137, and compliance with federal and state laws regarding the inspection and release of utility documents, I hereby authorize the use or disclosure of my utility information as described in this authorization.
Specific person/organization (or class of persons) authorized to provide information:
Specific person/organization (or class of persons) authorized to receive and use the information:
Purpose of the request:
Please state the purpose of the request. If you are the individual initiating this authorization and you do not wish to state a purpose, please state "At the request of the individual."
Right to revoke: I understand that I have the right to revoke this authorization at any time by notifying the City of West Allis in writing at 7525 West Greenfield Avenue, West Allis, WI 53214, Attn: City Attorney's Office. I understand that the revocation is only effective after it is received and logged by the City of West Allis. I understand that any use or disclosure made prior to the revocation under this authorization will not be affected by a revocation. I understand that after this information is disclosed, federal law might not protect it and the recipient might re-disclose it. I understand that I am entitled to receive a copy of this authorization. I understand that, unless revoked as set forth above, this authorization will expire on:
Enter date or event
If a personal representative executes this form, that representative warrants that he/she has authority to sign this form on the basis of:
Signature*
Date*
Date
West Allis Municipal Water Utility Mailing Address
6300 West McGeoch Avenue, West Allis, WI 53219
Office Hours
Monday-Friday 7:00am-3:30pm
Phone Number
(414) 302-8830
Fax Number
(414) 302-8889
Email
ubilling@westalliswi.gov

Leave This Blank:

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

This field is not part of the form submission.
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