Please complete all of the information on this form as completely and accurately as possible. Please use blue or black ink if filling this form out by hand. If your description of the billing dispute needs more room, please attach additional sheets to this form. Note: many questions may be answered by calling a Utility Service Specialist at our assistance number: 505-891-5020.
Please insert today's date
Please provide the name listed on the account
You can find the account number on the upper right hand corner of your monthly billing statement. Please provide the full account number including the dash.
Address, City, State, Zip
Please describe the nature of your billing dispute in the space above:
I agree that the dispute reported is within 60 days or less of the original dispute
This field is not part of the form submission.
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