SPRINGFIELD WATER AND SEWER COMMISSION
P.O. BOX 3688
SPRINGFIELD, MA  01101-3688
TELEPHONE 787-6060--FAX NUMBER 787-6269

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ATTORNEY: _______________________________DATE: __________________________________ 

FAX NUMBER: ____________________________PHONE NUMBER: _________________________ 

CLOSING DATE: ____________________ 

SELLERS INFORMATION (MANDATORY) 

PROPERTY:____________________________________________________________________________ 

PRIMARY READING: _______________________ AUXILARY READING:________________________ 

SELLERS NAME: __________________________________________ PHONE_______________________ 

SELLERS FORWARDING ADDRESS: _______________________________________________________ 

CITY, STATE & ZIP CODE ________________________________________________________________ 

BUYERS INFORMATION (MANDATORY) 

BUYERS NAME:____________________________________________PHONE______________________ 

MAILING ADDRESS: (AFTER CLOSING) ___________________________________________ 

CITY, STATE & ZIP CODE______________________________________________________________ 

CUSTOMER NUMBER: _____________________ 

FINAL BILL TOTAL: $ ______________________  

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PLEASE RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO: 

SPRINGFIELD WATER AND SEWER COMMISSION
P.O. BOX 3688
SPRINGFIELD, MA  01101-3688
CUSTOMER NUMBER: ___________________  FINAL BILL TOTAL: $ ___________________

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