Billing Dispute Form
City of Somerville Water & Sewer Department
Date
*
-
Month
-
Day
Year
Date
Account number
*
Bill number
*
Name
*
First Name
Last Name
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reason for dispute
*
Estimated read
Zero usage
Other
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Explanation
*
Upload any document that is related to the dispute (e.g pictures of meter, copy of bill
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