Change of Water Use/Billing Adjustment Request
Purpose
*
Change of Water Use
Request for Billing Adjustment
Water System
*
RDCK Water System Name
Street Address
*
(eg. 1234 Smith Street)
Account Number
5-digit (if known)
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Building Type
Single Family Dwelling
Manufactured Home in a Manufactured Home Park
Multi-Family Dwelling
Commercial Building
Property Type
Residential
Agricultural
Commercial
Industrial
Institutional
Description of Change/Billing Adjustment Request:
Date of change
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: