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2. Instructions
   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.
4. Date*
   Date
   Please insert today's date
5. Phone
6. E-mail Address
8. Account Holder's name*
   Please provide the name listed on the account
9. Account Number *
   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.
11. Service Address*
    Address, City, State, Zip
13. Dispute Information
    Please describe the nature of your billing dispute in the space above:
15. Acknowledgement and Signature*
    I agree that the dispute reported is within 60 days or less of the original dispute
16. Date*
    Date
    Please insert today's date
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

* indicates a required field