Customer Dispute Form Page 2

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Instructions on completing this form
1. This form must be completed by the owner or an Authorized Representative. If you are not authorized to
access this account, you must file a Letter of Authorization with DEP
2. Complete the entire form, including the account information and complaint description. Describe the issue as fully
as possible
3. Sign and date the form
4. Attach any additional documentation if desired. All additional documentation will retained by DEP
5. If you would like copies of the additional documentation, please make them before submitting the form. DEP will
only provide copies of the original form as a receipt of your complaint
Instructions on submitting this form
Customer Complaint
DEP/Bureau of Customer Services
1. You may submit this form at any BCS borough office
P.O. Box 739055
2. You may fax this form to (718) 595-5647
Flushing, NY 11373-9055
3. You may mail this form to DEP Bureau of Customer Service (BCS)
Please use this extra space for writing……
(Attach additional paper as needed)
About the written complaint process
You have the right to file a formal dispute of a disputed water and sewer bill with the Department of Environmental
Protection. Disputes must be submitted in writing within four years of the date of the bill in question.
DEP will provide a response within 90 days of receipt of the complaint.
You may read the appeal guidelines in full at For a copy by mail, call
(718) 595-7000. A representative is available from 9 a.m. to 6 p.m. on Monday through Friday and Saturday, from 9
a.m. to 2 p.m.
DisputeForm Back 7-18-2014

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