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Request Administrative Hearing
This Form is used for requesting an Administrative Hearing for billing issues, etc.
Name *
Phone Number 1 - ( ) - -
Service Address *
Service City *   State *   Zip *
Billing Address *
Billing City *   State *   Zip *
Account Number * -

Why is hearing requested? *

What, if any, additional facts do you wish to submit for review or discussion?

By Agreeing to this form, you understand that you will be notified by letter as to the date, time and place of the hearing to be conducted by the Customer Review Officer; You are allowed to examine all pertinent records of the Sewerage and Water Board; You may be represented by counsel, and will be notified by letter as to the final decision of the Customer Review Officer.

I Agree*