Poarch Creek Indians Utility Authority Formal Complaint Form printable pdf download

Poarch Creek Indians Utility Authority Formal Complaint Form

POARCH CREEK INDIANS UTILITY AUTHORITY

Formal Complaint Form

Please print in ink or type.

CUSTOMER (COMPLAINANT) INFORMATION

Your name, mailing address, county, telephone number, utility account number

and service address:

Name _______________________________________________________________

Street/P.O. Box _________________________________ Apt # __________________

City ________________________ State ____________ Zip ____________________

County _________________________

Daytime Telephone Number Where We Can Contact You:

(____)__________________

E-mail Address (optional): __________________________

Utility Account Number _____________________________

(from your bill)

If your complaint involves utility service provided to a different address

than your mailing address, please list this information below.

Name _______________________________________________________________

Street/P.O. Box ________________________________________________________

City ________________________ State ____________ Zip ____________________

TYPE OF UTILITY (check one

)

□

WATER

WASTE WATER

□

OTHER ___________________________

Poarch Creek Indians Utility Authority Formal Complaint Form