WASTEWATER WINTER AVERAGE ADJUSTMENT REQUEST FORM
PERSONAL INFORMATION
Applicant Name:
Phone # :
Account # :
Service Address:
(No. & Street, City, State, Zip Code)
Mailing Address:
(No. & Street, City, State, Zip Code)
GENERAL CATEGORY REQUESTS
(CHECK APPLICABLE ITEMS)
LEAKS
Repair Receipts Attached?
YES
NO
If NO, complete next item
Evidence of Payment (copys only)
Canceled Check
Money Order
Charge Slip
TRANSFERS
Residential Move
Previous Address
City, State, Zip
Current Address
MUST BE SAME AS SERVICE ADDRESS
Name Change
Previous Acct. Name
Previous Acct. #
Current Acct. Name
MUST BE SAME AS NAME ABOVE
Prior established service in consecutive months, at one location, under name of applicant (3 minimum)
Months
NEW CUSTOMERS
Number of consecutive full months of consumption, at one location, under name of applicant (3 minimum)
Months
OTHER
Please explain extraordinary circumstances in space provided.
Pressing the submit button will send the information entered to the City of Corpus Christi Utilities Business Office. Please verify that all the above information is correct before submitting. There will be no preview page.
