Water Account Transfer Form

Water Service Account Transfer
Property Information
Account Service Address*

Street Address

CityState / Province

Postal / Zip Code
Closing Date*

MonthDayYear
DateHourMinutesAM/PM Option
Seller Information
Seller Name*

First NameLast Name
Seller's Email
example@example.com
Seller's Attorney*

First NameLast Name
Attorney's Email*
example@example.com
Attorney's Phone*

Area CodePhone Number
The seller is responsible for a $50 closing fee that will be included with the current amount due from the seller at the time of closing. Payment for the closing fee should be paid at the closing. Please mail checks (no cash) to the Albany Water Department, 10 N Enterprise Drive, Albany, NY 12204. PLEASE DO NOT SUBMIT ATTORNEY'S NUMBERS AS THE BUYER'S NUMBER. WE WILL REJECT THE SUBMISSION AND YOU WILL HAVE TO RESUBMIT AGAIN WITH ALL THE PROPER AND ACCURATE INFORMATION THAT IS ASKED.*

Acknowledged
Buyer Information
Buyer's Name*

First NameLast Name
Buyer's Phone Number*

Area CodePhone Number
Buyer's E-mail*
Buyer's Mailing Address *

Street Address

Street Address 2

CityState / Province

Postal / Zip CodeCountry
Buyer's Attorney*

First NameLast Name
Attorney's Email*
example@example.com
Attorney's Phone*

Area CodePhone Number
Form Submitted By:*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
I certify that the information entered is correct. The correct contact information for the Buyer is required and cannot be substituted with the Attorney's contact information. If any false information is provided, the application will not be processed and will need to be resubmitted. THE CORRECT MAILING ADDRESS AND CONTACT PHONE NUMBER FOR THE BUYER IS REQUIRED IT SHOULD NOT BE THE SAME AS ATTORNEY*

Acknowledged
Suggestions if any for further improvement:
On Taxes
Total Credit to Purchaser
Current Balance Due
Official Use Only
Closing Read
Closing Read Date

MonthDayYear
Date
Last Billed Read
Last Billed Read Date

MonthDayYear
Date
Consumption
# of Days
Senior Discount
Service Period
Next Bill Issued

MonthDayYear
Date
Route
Customer Service Rep
Should be Empty:

Water Service Account Transfer

Property Information

Seller Information

Buyer Information

Official Use Only