Registration For Water & Sewer Billing

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REGISTRATION FOR WATER & SEWER BILLING
Please use this form for newly purchased property or mailing address updates.
Submit it to:
DEP-BCS
Attn: Registration Unit
59-17 Junction Blvd, 7th Floor
Flushing, NY 11373
PROPERTY INFORMATION/SERVICE ADDRESS:
ACCOUNT NUMBER: __ __ __ __ __ - __ __ __ __ __ - __ __ __
Borough: _____________________________
STREET ADDRESS: _______________________________________________
Block: ________ Lot: ____________
CITY: _____________________
STATE: NEW YORK ZIP: ___________ Purchase Date: _____________________
OWNER’S CONTACT INFORMATION:
------------Please print clearly------------
OWNER NAME: ________________________________________________________________________________________________
First
Last
SECOND NAME or BUSINESS NAME: ____________________________________________________________________________
First
Last
CONTACT INFORMATION: (Email) ________________________________________________________________________________
MOBILE PHONE: ___________________________________
EVENING/HOME PHONE: ________________________________
CHECK THE CORRECT BOX(ES) BELOW AND SIGN:
communications to the Service (Property) Address shown above. I acknowledge that charges issued against the
property must be paid in full by the due date listed or interest charges will be imposed.
__________________________________________
________________________________________
Signature of Owner
Date
Second Signature
Date
)
)
ALTERNATE or DUPLICATE BILL MAILING INFORMATION:
Alternate
Duplicate Bill Copy
communications to the Name(s) and Address(es) shown below. I acknowledge responsibility for ensuring charges
issued against the property must be paid in full by the due date listed or interest charges will be imposed.
________________________________________
_________________________________________
Signature of Owner
Date
SEND BILLS TO A DIFFERENT ADDRESS:
SEND DUPLICATE BILLS TO:
______________________________________________
______________________________________________
Name
Name
______________________________________________
______________________________________________
Second Name/Attention:
Second Name/Attention:
______________________________________________
______________________________________________
Street Address (Apt/Room)
Street Address (Apt/Room)
______________________________________________
______________________________________________
City
State
Zip
City
State
Zip

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