Address Change Request

Change of address for property, structures and/or services.

NOTE: Required fields are indicated in red. They must be completed for the Address Request to be processed. If you do not have the required information, please obtain it before completing this Address Request.

FEES: A fee for address change request may apply. Please see the following link for the ADDRESS ASSIGNMENT section of the Schedule of Charges (SOC). Change will be made upon receipt of payment to Memphis Light, Gas and Water.

Address To Be Changed

Current Address:

Reason for Requesting Change

	Out of sequence with surrounding addresses
	Mail Delivery Issue
	Emergency Response Issue
	Other (Explain)

Use Type:

Location Description

Is the lot in a subdivision?

Site Plan

Attach surveyed site plan (DWG, TIF, PDF, SHP, GIF, JPG - DWG preferred)
Please email AutoCad site plans to Address.assignment@mlgw.org
We will process your request upon receipt of drawing file(s).

Requestor (Owner Representative) Information

Your Company:		Owner Email:
Contact Phone:		Contact Cell:
Contact Fax:		(e.g., 901-555-1234 or 9015551234)
Contact Email:

Owner/Responsible Party for Property/Address

Owner Name:
Contact Name (if different from owner):
Company Name (if applicable):
Address:		City:
State:		ZIP:
Contact Phone:		Contact Cell Phone:
Contact Email:		Contact Fax:

Purpose of Address

Choose One:

Special Instructions:

(see Street Naming Guidelines on our website or click here to locate the document)