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Request for Water Budget Adjustment (Residential Properties)

This form must be completed and signed by the water service account holder. Incomplete or incorrect or unsigned
forms will not be accepted
. Requests for water budget adjustments may take up to six weeks to be processed and applied to your account. Western will not make retroactive changes to water budgets nor reverse or credit penalties incurred during the processing period. All requests for water budget adjustments are subject to periodic review by Western, including after the request has been approved. You will be notified regarding the status of your request by U.S. mail.

I, the above mentioned water service account holder, request an adjusted water budget for the above noted
water service account number for the following reason(s):