Fillable WATER DEPARTMENT FORMAL DISPUTE FORM (City of Highland City)

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WATER DEPARTMENT FORMAL DISPUTE FORM (City of Highland City)

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The WATER DEPARTMENT FORMAL DISPUTE FORM (City of Highland City) form is 1 page long and contains:

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  • 4 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

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CITY OF HIGHLAND PARK
Office the Water Department
Director - Damon L. Garrett, PE
Metro Consulting Associates, LLC
City of Highland Park Water Department
14110 Woodward Avenue
Highland Park, MI
WATER DEPARTMENT FORMAL DISPUTE FORM
Customer’s Name:
Property Address:
Phone:
Location ID or Account Number:
Date of Customer Bill in Dispute:
Amount in Dispute:
Reason for Dispute (check all that apply)
Excessive Usage Estimated Bill Late Fees/Penalties Meter Issue
Other (please specify):
Briefly state the grounds or basis upon which you believe the charges are incorrect. Attach additional
documentation if needed.
I certify that all statements made on this application are true and correct to the best of my knowledge and belief, and I understand that the making of any
willful false statement of material fact herein will subject me any laws against making and filling of false instruments.
Date:
Printed Name of Customer: Signature of Customer:
The Following Section is to be Completed by Water Department Staff
Proposed Informal Resolution: Date:
Formal Resolution: Date:
Please return form to the City of Highland Park Water Department at 14110 Woodward Avenue.
Or email to: hpwaterdepartment@metroca.net
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WATER DEPARTMENT FORMAL DISPUTE FORM (City of Highland City)

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Completed 23 January 2021

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