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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.