2. Service requests will be responded to during customer service hours: Monday - Thursday, 7:30 a.m. to 5:30 p.m.
4. Name*
5. Email Address*
7. RMLD Service Address*
9. City*
10. State*
11. Zip Code*
13. Primary Phone Number*
14. Is this a cell phone number?*

    1. Yes
    2. No
16. Cell Phone Number (if different from above)
17. What type of account is this?*

    1. Residential
    2. Commercial/Industrial
19. Are you the: *

    1. Property Owner
    2. Tenant
20. If you are a tenant, please call RMLD at 781-942-6598 to schedule your required deposit.
24. Are you looking to start or stop RMLD service?*

    1. I am looking to start service
    2. I am looking to stop service
26. What is the requested service start date?*
    What is the requested service start date?
27. Is the property new construction?*

    1. Yes
    2. No
29. Is the billing address the same as the service address?*

    1. Yes
    2. No
30. Have you ever been an RMLD customer before?*

    1. Yes
    2. No
32. If the billing address is not the same, please enter the billing address below:
33. If you have been an RMLD customer before, please provide account number:
35. RMLD Account Number*
36. Stop My Service Effective:*
    Stop My Service Effective:
38. What is your forwarding address?*
40. If you are a tenant stopping service, please provide the name and contact information for your landlord.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field