Water/Wastewater Adjustment Request

 

 

Reason for Adjustment *
Date of Reason for Adjustment
Files must be less than 2 MB.
Allowed file types: jpg jpeg pdf doc.

 

By selecting the “I Accept” button, you are signing this Adjustment form electronically. You agree that your electronic signature is the legal equivalent of having signed this form in writing. 

You also agree to keep your account current during the adjustment period. Any adjustment to your bill will be included on a future billing as a credit against the balance of the account. Failure to keep the account current may result in fees added to the account. To discuss the option of a payment plan, I understand I will need to contact the Finance Department at the City of Lebanon prior to the account’s due date.