Change of Address

Blountville Utility District

P.O. Box 469 | Blountville, TN 37617 | 423-323-2189

Change of Address

Customer's Name

Account Number

Phone Number

Old Address

City

State

Zip Code

New Address

City

State

Zip Code

Effective Date

Acknowledgement

I submit this change of address and acknowledge all information to be true and correct.

Customer Name (Signature)

Location