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2. HELP US CONTACT YOU IN EMERGENCIES!
4. As part of our ongoing efforts to enhance communications & improve customer service, Mukilteo Water and Wastewater District ("MWWD") needs YOUR help!
   In the event of an emergency, such as a water/sewer main break or water contamination situation, we need to be able to reach you quickly. The District will never sell or otherwise distribute this information to any other parties. This information is sent directly to our customer service staff, and will only be used for contacting you regarding District business matters.
6. Please do not use this form to inform MWWD of the purchase or sale of a property; please use the appropriate purchase/sale forms instead.
8. Please provide us with the following to update/confirm the contact information on your account:
10. First Name*
    As it appears on your statement.
11. Last Name*
    As it appears on your statement.
13. Choose One:*
    -- Select One --OwnerTenant
15. Your customer account number
17. Service Address*
19. City
20. Zip Code
22. Billing Address*
24. City*
25. State*
26. Zip Code*
28. Primary Contact Number*
    (This is the number we will use in case of an emergency)
29. Secondary Phone Number
31. Email Address*
    MWWD never sells or distributes any of your information, including email addresses, to anyone. Your email address is needed strictly for purposes of emergency communication with the District.
33. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) this form 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.
35. Electronic Signature*
    I affirm that the above information is true & correct.
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field