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Water & Sewer Move Out Work Order Form
Name (as shown on utility bill):
Service address:
Holland Charter Township account number:
Phone number:
Cell number:
E-mail:
Final my account as of (date):
Please enter the final date that your account should be billed
Forwarding address to send my final bill:
Street address:
City
State
ZIP
Please confirm you have received and processed my Move Out Work Order by:
Calling me
E-mailing me
Comments:
Submit
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