YSPUC CUSTOMER INFORMATION FORM

YSPUC Customer Information Form
OWNERTENANT
(If Tenant, please provide Owner/Property Management information below)
Account #
Name

First NameLast Name
Lot Number
SERVICE ADDRESS
Street Address in YLP
MAILING ADDRESS

(IF DIFFERENT FROM SERVICE ADDRESS)
Mailing Address
State
Zip Code
CORRESPONDENCE OPTION (CHOOSE ONE)
Billing OnlyBilling & Communication
E-mail 1
example@example.com
E-mail 2 (if more than one)
example@example.com
PHONE NUMBER
Home Phone
Cell Phone
OWNER/PROPERTY MANAGEMENT INFORMATION
Name

First NameLast Name
Company Name
Mailing Address:
Address
State
Zip Code
Phone Number
E-mail
example@example.com
Should be Empty: