Skip to form
SeamlessDocs

BOARD OF WATER AND SEWER CHARGE REVIEW REQUEST FORM

The information must be filled out in its entirety. Ensure that the correct deposit is remitted prior to forwarding this complaint/dispute to the Board of Water and Sewer Charge Review.

Guidelines for Required deposit:
· For an account to be considered for review, a written appeal must be received within 2 billing cycles of the date of disputed bill and comply with the deposit requirements below per Dayton Water Rules & Regulations Section 2N.2.

Guidelines for Required deposit:
· A review request filed AFTER the due date, but before the shut-off notice has been generated requires a 25% deposit.

· AFTER the shut-off notice has been generated, a 50% deposit is required.
· If the service has been shut-off, but turn on is not being requested, a 50% deposit is required.
· If the service has been shut-off and you are requesting reinstatement, a 100% deposit is required. The total balance must be paid in full prior to a review of your complaint.

Payments can be made online at PayDaytonWater.com, in person in City Hall, or through the IVR by calling 937-333-3550. The deposit payment must post to your account before your complaint is reviewed.
Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
Signature HereClick to Sign
02/24/2024Click to Sign
I.N.Will Update Upon Signing
I.N.Will Update Upon Signing
Signature HereSandra Taylor Will Sign Here
02/24/2024
I.N.Will Update Upon Signing
I.N.Will Update Upon Signing
02/24/2024

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

x

Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

x

Additional Signatures Required

Supporting Documentation Click Here to Upload