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2. Reason for update (check all that apply):
4. 1. Name Change
6. Old Name
7. New Name
9. 1. Mailing Address Change

   Be sure to include City, MI Zip if the address is not in Grand Ledge.

11. Old Address
13. New Address
17. Name on Account
18. Email Address
19. Phone Number
21. Service Address
23. Mailing Address (if different than service address)
27. Unpaid bills are a lien on the property. Failure to receive a bill does not waive penalty.*

    1. I understand.

    I agree I will be responsible for any damage to the property of the City of Grand Ledge caused by my negligence. I agree to promptly pay any water/sewer bills, along with any fees I may incur. I understand that failure to make timely payment may result in the City of Grand Ledge using all means permitted by law to collect the debt.

29. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Electronic Signature
Leave This Blank:


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

    This field is not part of the form submission.

35. Submit

* indicates a required field