Election Of Metered Billing For Multi-Family Properties
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1ELECTION OF METERED BILLING
FOR MULTI-FAMILY PROPERTIES
PROPERTY INFORMATION/SERVICE ADDRESS:
Account Number: ____________________________________________________________________________________
Service Address: _____________________________________________________________________________________
Street Address
City, State and Zip
Borough: _______________________________________________________
Block: ___________
Lot:___________
Property Owner: ______________________________________________________________________________________
No. Of Buildings: __________
No. Of Residential Units: ___________
No. Of Commercial Units: __________
CONTACT INFORMATION:
Contact: _____________________________________________________________________________________________
Phone No.: ___________________________________
Best Time to Call: _________________________________
Cell Phone No.: _______________________________
Email Address: ___________________________________
Mailing Address: _____________________________________________________________________________________
City:_____________________________________________
State:__________________
Zip: __________________
DO NOT RETURN THIS FORM UNLESS YOU WISH TO BE PLACED ON METERED BILLING IMMEDIATELY
I hereby certify that I am the owner or owner’s authorized agent, as confirmed in the attached letter of
authorization, and request that the above-referenced property be billed on a metered basis in accordance with
Part IV Section 2 of the New York City Water Board Water and Wastewater Rate Schedule. I understand that the
conversion to metered billing will be effective as of the date DEP obtains a reading after my request is received
and that my request may be denied if this form is incomplete (e.g., not notarized), if I fail to facilitate access to the
meter, or if my meter is determined to be defective or not installed to the satisfaction of DEP. I also understand
that my metered charges may increase in the future due to the installation of a new meter.
I understand that my election of metered billing is irrevocable for a period of two years. I also understand that if
this request is denied, my residential usage will continue to be billed on a flat-rate basis.
Print Name: _______________________________________________________________________
Signature:
__________________________________________________ Date: _______________
Please return this form to:
NYC Department of Environmental Protection
Bureau of Customer Services/Correspondence Unit
Notary:
59-17 Junction Boulevard, 7th Floor
Flushing, NY 11373-5108
December 2015
Form No. 950-0012
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