Monthly Meter Reading Form

Here is my meter reading for the current month.
We have added lines, at customer request, for submitting more than one account number or meter reading on the same form.

Name:
Account Number 1:
Account Number 2:
Account Number 3:
Account Number 4:
Account Number 5:
Meter Number 1:
Meter Reading 1:
Meter Number 2:
Meter Reading 2:
Meter Number 3:
Meter Reading 3:
Meter Number 4:
Meter Reading 4:
Meter Number 5:
Meter Reading 5:
Phone:
Date: