Inquiry / Complaint Form

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Account Number(Required)

Email(Required)

Reason for inquiry/complaint

Did you speak to an Authority representative? If so please list the name of the representatives and dates contacted

Did our Authority representative sufficiently explain Authority rules and policies to you?

If this involves a termination, is your water off or on?

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