Baseline Reallocation request

"*" indicates required fields

Service Number*

Service Address*

Street Address City State ZIP Code

Customer Name*

Phone*

Customer Email Address*

Reason for Modification*

Existing Baseline per Billing Month

JAN/FEB: Baseline (ccf)*

MAR/APR: Baseline (ccf)*

MAY/JUN: Baseline (ccf)*

JUL/AUG: Baseline (ccf)*

SEP/OCT: Baseline (ccf)*

NOV/DEC: Baseline (ccf)*

Water Budget*

*The water budget must remain the same after reallocating the baselines.

Requested Adjustments per Billing Month

JAN/FEB: New Baseline (ccf)*

MAR/APR: New Baseline (ccf)*

MAY/JUN: New Baseline (ccf)*

JUL/AUG: New Baseline (ccf)*

SEP/OCT: New Baseline (ccf)*

NOV/DEC: New Baseline (ccf)*

Water Budget**

*The water budget must remain the same after reallocating the baselines.

Baseline adjustments shall apply to only current and future bills; no baseline adjustments will be used to retroactively adjust previous bills.

You may request a baseline reallocation at any time, but only months not yet billed can have their baseline amounts reallocated. Please note that fees may apply.

Name*

Customer / Representative

Date*

Title*

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Baseline Reallocation request – Bi-monthly Billing

Baseline Reallocation Request

Existing Baseline per Billing Month

Requested Adjustments per Billing Month

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