Customer 7 Digit Account Number
*
Ward, Block & Lot (if the account number is not available)
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Final Reading Date
*
-
Month
-
Day
Year
Date
Property Closing Date
*
-
Month
-
Day
Year
Date
Seller's Real Estate Information
Seller's Real Estate Agent
*
First Name
Last Name
Agency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Agency Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Owner's Information
Current Owner (Seller)
*
First Name
Last Name
Phone Number (Seller)
*
Please enter a valid phone number.
Format: (000) 000-0000.
New Owner's Information
New Owner (Buyer)
*
First Name
Last Name
Phone Number (Buyer)
*
Please enter a valid phone number.
Format: (000) 000-0000.
New Owner's Billing Address same as Property Address?
*
Yes
No
New Owner's Billing Address (only if future billing address differs from property address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Check if New Owner is interested in being contacted about Pittsburgh Water's Customer Assistance Programs
Final Bill Delivery Method
*
Hold for Pick-Up
Mail Final Bill
Email Final Bill
Name for Final Bill
*
First Name
Last Name
Mailing Address for Final Bill
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address for Final Bill
*
example@example.com
Final Water Meter Reading
*
Is the property vacant or has it been vacant?
*
Yes
No
If yes, for how long?
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Signature
*
Signature Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Continue
Continue
Should be Empty: