Form Bcs-7crf - Customer Registration For Water And Sewer Billing
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1950-0006b - Customer Registration Form for Water and Sewer Billing (online version), Rev. 07/2013
This form is a duplicate of the original published on DEP website
The City of New York
Department of Environmental Protection
Bureau of Customer Services
59-17 Junction Boulevard
Flushing, NY 11373-5108
Customer Registration Form for Water and Sewer Billing
Property and Owner Information:
(1) Property receiving service is located in the Borough of
Block:
Lot:
(2) Account Number (if applicable):
Meter Number (if available – include the letter):
(3) Street Address of Property Receiving Service:
Street
City
State
Zip
(4) Full name, mailing address, home phone and business phone numbers of owner of property receiving service:
(please provide information on owner ONLY; do NOT give information on property manager or tenant):
Owner’s Name
Business:
or Individual:
(Last Name)
(First Name)
(MI)
Street
City
State
Zip
Home Phone (Numbers Only):
Business Phone (Numbers only):
Additional Billing Information
PLEASE NOTE:
A. Water and sewer charges are the legal responsibility of the owner of a property receiving water
and/or sewer service. The owner’s responsibility to pay such charges is not affected by any
lease, license or other arrangement, or any assignment of responsibility for payment of such
charges.
B. Water and sewer charges constitute a lien on the property until paid. In addition to legal action
against the owner, a failure to pay such charges when due may result in foreclosure of the lien
by the City of New York, or the property being placed in a lien sale by the City.
C. Original bills for water and/or sewer service will be mailed to the owner, at the owner’s address
specified on this form. DEP will provide a duplicate copy of bills to one other party (such as a
managing agent) if so requested below, provided, however, that any failure or delay by DEP in
providing duplicate copies of bills shall in no way relieve the owner from his/her/its liability to
pay all outstanding water and sewer charges.
(5) If you would like a duplicate copy of bills sent to another party, please check here
and fill out the following
information:
Name of Party to Receive Duplicate Copies of Bills:
(6) Mailing Address: Street
City
State
Zip
(7) Relationship to Owner (check one): Managing Agent
Mortgagee
Tenant
Other (please explain):
Owner’s Approval and Signature
The undersigned certifies that he/she/it is the owner of the property receiving service referenced above; that he/she/it
has read and understands Paragraphs A, B, C under the section captioned “Customer Billing Information”; and that
the information supplied by the undersigned on this form is true and complete to the best of his/her/its knowledge.
(8) E-mail:
(9) Name of Owner:
(10) Signature: _______________________________________________________________________________
Name and Title of Person Signing for Owner, if applicable:
(11) Date: (mm/dd/yyyy):
/
/
BCS-7CRF REV.7.13
Page 1 of 2
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