Payment Deferral Request Form

To Residential Consumers of the West Hempstead Water District:
As per a recent amendment to Public Service Law, residential consumers who have experienced financial hardship as a result of the COVID-19 pandemic may apply for payment deferrals, without incurring late fees or penalties. Accordingly, the Board of Water Commissioners of the West Hempstead Water District is offering residential consumers the opportunity to apply for water bill payment deferrals. Once approved, payments will be deferred until the next quarterly bill due date.
This online form to be completed by the water service address property owner or authorized representative:
*
- As the owner of the property listed below (or authorized representative), I attest that I have experienced financial hardship as a result of the COVID-19 pandemic. As such, I am requesting enrollment in the West Hempstead Water District Payment Deferral Program.*
*
- I acknowledge that I am required to pay each bill in full. I understand that any unpaid balance remaining after the deferral program has ended, may be submitted to the Town of Hempstead (per section 215, subdivision 12 of the Town Law of the State of New York) and added to my next scheduled tax bill.*
Water Account Number*
Water Service Address*
Street Address Address Line 2 City State ZIP Code
Email*
Home Phone
Cell Phone*
Check One*
- Owner
- Authorized Representative
Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Once you provide your consent and submit this form, your information will be sent to one of our office administrators for review. Acknowledgment of your deferral request will be sent to you via email.
Consent
I agree to the statement above.
* Required Field

Rates and Schedule

2020 Water Rates

Residential Rates

Up to 2,000 gallons: No charge
2,001 to 10,000 gallons: $1.50 per 1,000 gallons
10,001 to 25,000 gallons: $2.00 per 1,000 gallons
25,001 to 40,000 gallons: $2.50 per 1,000 gallons
40,001 to 60,000 gallons: $3.00 per 1,000 gallons
60,001 gallons and over: $3.50 per 1,000 gallons

Commercial Rates

Up to 10,000 gallons: $1.65 per 1,000 gallons
10,001 to 25,000 gallons: $2.20 per 1,000 gallons
25,001 to 40,000 gallons: $2.75 per 1,000 gallons
40,001 to 60,000 gallons: $3.30 per 1,000 gallons
60,001 gallons and over: $3.85 per 1,000 gallons

2020 Billing Schedule

The District is split into three zones. Each zone is billed quarterly. The schedule is as follows:

One portion of the district receives their bills in January, April, July and October (each covering the previous three months).
The second portion of the district receives their bills in February, May, August and November (each covering the previous three months).
The last portion of the district receives their bills in March, June, September and December (each covering the previous three months).

Payment Deferral Request Form

To Residential Consumers of the West Hempstead Water District:

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