2. In accordance with the Federal Trade Commission (FTC) Red Flag Rule, the Village of Little Chute requires proof of identity for all customers. This policy is designed to detect, prevent, and mitigate identity theft in conjunction with opening and maintaining a utility account. 

   Current account information is as follows. 

4. Name on Account:
5. Last Name
7. Account Number
9. Service Address
10. Apt. #
12. City
13. State
14. Zip
16. Cell Phone
17. Email Address

21. Revisions
    Purpose of completing this form is to update my personal information as follows 
    (only complete those fields that are changing)

23. Name on Account
24. Last Name
26. Mailing Address
27. Apt
29. City
30. State
31. Zip
33. Home Phone
34. Cell Phone
36. Email
38. Other Updates

    Please list any other updates we should be aware of.

40. Submit*

    1. I agree

    By Submitting this form I certify that the above information is mine and all statements on this form are true and correct.

42. First Name
43. Last Name
Leave This Blank:


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

    This field is not part of the form submission.

47. Submit

* indicates a required field