* indicates a required field

2. City of Blythe
   Utility Billing Department
   REQUEST FOR UTILITY INVESTIGATION
   235 N Broadway Blythe, 92225
   760-922-6161 Ext 1233 or 1234
4. 
   Section 13.04.110 of the Blythe Municipal Code provides for the following:
   
   A customer may register a complaint or request an investigation of charges within five (5) days of receiving the disputed bill.
   
   The request must be received in writing no later than 10 days after the mailing of the bill (5 days allowed for mail delivery).
   
   
6. If you feel that your water bill is not correct please complete the following:
8. Customer Name*
10. Service Address*
12. Service Account #*
13. Contact Phone #*
14. Contact Phone # Type*
    -- Select One --CellHomeWork
16. Reason for Request:*

18. Depending upon the volume of rechecks requested the City may take up to five (5) business days to investigate your request. You will receive notification of these results and if applicable, an adjustment may be made at that time. We understand that water consumption can increase significantly during the summer months, making the water bills high. The City appreciates your cooperation and support.

20. Customer Signature*

    A signature is required to process your request. By entering your valid email address in the box below you are signing this form and confirming that the above information is correct.

21. Date*
    Date
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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