Please complete and submit this form only if:

• your name or street address is incorrectly shown on your bill
• your name, phone number or street address has changed recently
• your email address (that we use for eBill) has changed
• you need to update the Tax ID Number for your business

If the name on the account needs to be transferred to a different person or business, we'll need to talk to you. Please call our toll-free Customer Assistance number at 1-877-434-4100 during business hours.

(* required)
Account Verification
* Account Number:		-
* Name on Bill:
* Account Phone Number:		- -
Tax ID Number (business customers):
Contact Information
Title:		(Ex: Mr., Ms., Dr.)
* First Name:
* Last Name:
* E-mail Address:
* Confirm E-mail Address:
*Is this a new e-mail address?		Yes No
Yes, please send me e-mails about exclusive programs and services from Orange & Rockland:
Name Change
Correct Name:
Reason for Change:
If this is a legal name change, please provide date when change occurred:		/ /
Phone Change
Correct Phone Number:		- -
Service Address Change
Correct Street Address:
City:
State:		NY NJ PA
Zip:
Mailing Address Change
Correct Mailing Address: (if different than Service Address)
City:
State:
Zip:
Message/Comments:
		Remember my contact information