Sewer Adjustment Request
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Short description of issue
*
0/1000
Back
Next
Date of Repair
*
-
Month
-
Day
Year
Date
Upload File 1
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If you have an invoice or receipt of payment please upload here.
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of
Were you notified by a City of Jacksonville staff member about high usage?
Yes
No
If your adjustment is approved - what is the best way to notify you of the adjusted amount. You will not receive an adjusted bill, it will appear on your next statement.
E-mail
Phone
No communication required
Other
Are there any departments/members that you would like to recognize
Utility Billing
Metering
Lines Maintenance
Customer Service Specialist
Other
Any additional comments or concerns please list below:
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