The above information is incorrect. Please update my account with the following information.
Designee Verification Form
Version 1.0 : Revised July 1, 2014
Central Basin Watermaster - Designee Verication Form 4040 Paramount Boulevard • Lakewood, CA, 90712 • Tel: (562) 921-5521 • Fax: (562) 921-6101 • email: watermaster@wrd.org
Central Basin Watermaster
Please confirm that the information regarding your account currently on file with the Central Basin Watermaster is com-
plete and accurate.
The above information is correct.
Designee:
Title:
Party Name:
Mailing Address:
Telephone:
Email:
Designee:
Title:
Party Name:
Mailing Address:
Telephone:
Email:
Signature:
Print Name:
Title:
Date:
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signature
click to edit
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