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Final Water Bill Request Form

  1. Disclaimer

    Please be advised that when submitting this form, you are affirming that all entries and information is correct and true. There will be no tolerance for fraudulent information.

  2. Please fill out the full name listed on the account.

  3. If you choose to have your final water bill emailed, please be advised that this is the email to which the bill will be sent.

  4. You must fill out the Old Westbury service address, your form is not valid if any other address is entered here and you will be asked to resubmit a new form.

  5. Please provide the date of pick up from Village Hall. This date can be no sooner than one day before the closing date.

  6. Please provide the mailing address to which we can send your final water bill. Please note that all bills will be processed as close to the closing date as possible for accuracy. Note that if you choose a mail only option, it may not make it in time for the closing.

  7. Please provide the fax number to which we can send your final water bill.

  8. Leave This Blank:

  9. This field is not part of the form submission.