Residential Payment Form

Please fill out the form below to let us know your billing preference.

    First Name (required):
    Last Name (required):

    Phone Number (required):

    Address (required):
    City (required):
    State: New York (our service Area)

    ZIP Code (required):

    Your Email (required):

    What payment program are you interested in?

    Are you a senior citizen (62 and older)? YesNo

    Are you an existing customer? YesNo

    If you already have service with us please provide your Customer Number (if you have it):

    Any other comments?: