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Water for the North West
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Liability for charges form
This form is not an acceptance of your water charges dispute. We will investigate based on the information you
have provided and respond within 10 working days. Please return your completed form to United Utilities PO Box 453,
Warrington, WA55 1SE
About you
Title (please tick)
Mr Mrs Miss Ms Other (please state)
Full name
Address
(including postcode)
Daytime telephone number
Evening telephone number
Mobile telephone number
Email
Customer account number
(shown on top of your bill)
Date you received the Intention
to Bill letter
D D M M Y Y Y Y
Please provide details of the address you are contacting us about if this is dierent from the above. Please also detail why you believe
you are not liable for the water charges at this address.
Please list below the documents that you have sent to support your claim. Acceptable forms of proof are council tax exemption or
council tax surcharge for the address detailed above dated in the last 6 months.
I confirm that the information on this form is correct.
Signature Date D
D M M Y Y Y Y
click to sign
signature
click to edit
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