Harriman, NY · Orange County
Utility E-Bill Authorization Form
The Utility E-Bill Authorization Form lets Harriman water customers enroll an account in electronic utility-bill delivery instead of receiving statements by mail.
What this form is
This form authorizes the Village of Harriman to send utility bills for an account to the customer’s email address instead of mailing statements. It asks for the customer name, account number, service address, email address and contact telephone number, and includes terms about email delivery and billing responsibilities. The customer signs and dates the authorization.
Who needs it
Harriman water customers who want to receive their utility statements electronically rather than by mail should complete this authorization.
How to submit it
Return the completed form to the Village of Harriman, 1 Church Street, Harriman, New York 10926. It may also be sent by fax to 845-782-2016 or email to [email protected].
About notarization
This document is signed and dated without a notary; it does not mention a notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Utility E-Bill Authorization Form.
- 2
Complete The Customer Details
Enter the customer name, account number, service address, email address and contact telephone number.
- 3
Review And Sign
Read the terms and conditions, then sign and date the authorization.
- 4
Return The Form
Send the completed form to the Village of Harriman by mail, fax or email using the contact details on the form.
Frequently asked questions
- What does the Utility E-Bill Authorization Form do?
- It authorizes the Village of Harriman to email utility bills for the listed account instead of sending statements by mail.
- Do I need a notary for the Utility E-Bill Authorization Form?
- No. The form calls for the customer’s signature and date, but does not require notarization or mention a notarized or sworn attachment.
- How do I submit the Utility E-Bill Authorization Form?
- Return it to the Village of Harriman at 1 Church Street, Harriman, New York 10926, or send it by fax to 845-782-2016 or email to [email protected].
- What information does the form request?
- It requests the customer name, account number, service address, email address and contact telephone number, along with the customer’s signature and date.
Need something notarized?
This Utility E-Bill Authorization Form doesn’t need a notary — but if you have another Harriman form that does, a commissioned online notary can help.