No longer responsible for water bills

Title: * Mr Mrs Ms Miss Dr

First name: *

Surname: *

United Utilities account number: You can find this on your water bill

Please indicate your preferred daytime number: * Home Work Mobile

Telephone (Home):

Telephone (Work):

Telephone (Mobile):

Email:

House name/number: *

Flat name/number (if applicable):

Road/street name: *

Town:

City:

County:

Postcode: *

Date that you ceased to be responsible for water bills at this address: * Day  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2005 2006 2007 2008 2009 2010

Meter serial No. (if known):

For household customers your meter will have 4 or 5 digits on a black or white background, followed by 2 or 3 in a red background. Include all the numbers on the black or white background and ignore all the red ones

Please supply the meter reading for when you moved in (if the property has a water meter):

Name of person now responsible for water bills at this address (if known):

Title: Mr Mrs Ms Master Miss Dr Rev

First name:

Surname:

House name/number: *

Flat name/number (if applicable):

Road/street name: *

Town:

City:

County:

Postcode: *

If you have any queries, please let us know in the space provided: