CITY OF ATLANTA BUREAU OF DRINKING WATER

Water Service Adjustment Request

DATE: Dear Customer Service: We have received a high water bill for service at Account Number: leak was discovered which has been repaired by I understand that it is my responsibility to furnish proof that the leak existed and that repairs have been made. Date of repair(s) Location of repair(s) I have enclosed a purchase receipt and/or statement from repair person. a plumber’s receipt report A/an ;

Please approve the maximum credit to adjust my account. Name: Mailing Address: Service Address: Phone
Street Street City City State State Zip Zip

Work:

Home:

OFFICE USE ONLY: Cycle Customer Service Personnel Date

City of Atlanta Department of Watershed Management
55 Trinity Avenue, S.W Atlanta, Georgia 30303  Phone # 404-658-6500  Fax 404-602-4402

CITY OF ATLANTA BUREAU OF DRINKING WATER

Water & Sewer Appeals Request

Date: Name: Service Address: Mailing Address: City: Home Phone: Billing Date(s) of Disputed Bill NATURE OF APPEAL State: Business Phone: Zip Account No.:

Note: All current charges and any past due amount that is not in dispute must be paid in order to avoid interruption of water service. Please return this form within five (5) days of receipt to: Bureau of Drinking Water Attn: Water & Sewer Appeals Request Customer Service Division
651-14th Street N.W

Atlanta, Georgia 30318 City of Atlanta Department of Watershed Management
55 Trinity Avenue SW Atlanta, Georgia 30303  Phone # 404-658-6500  Fax 404-602-4402

CITY OF ATLANTA BUREAU OF DRINKING WATER

Plumber’s Statement

1. Name (Mr/Mrs./Ms.): 2. Address (Business):

3. Telephone number # (Business):

4. Date of Repairs: 5. Type of Repairs: 6. Specific Location of Repairs: 7. Purchase Receipt(s): (Hardware- Parts Used):

OFFICE USED ONLY:
Date Time Employee Name

City of Atlanta Department of Watershed Management
55 Trinity Avenue SW Atlanta, Georgia 30303  Phone # 404-658-6500  Fax 404-602-4402