Dispute Resolving Board (DRB) Review Request Form

Dispute Resolving Board (DRB) Review Request Form
Disputed charges will be temporarily removed from the account pending the decision of the DRB. All undisputed charges must be paid as they become due.
Date

MonthDayYear
Date
Customer Information
Name

First NameLast Name
Account Number (if known)
Premise Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Preferred way to contact you?
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Meter Readings

If the property is served by an inside water meter, please provide the current 7 or 8 digit meter reading. (Include any stationary “0's.”). Alternatively, if you prefer, you may submit a picture of the meter reading along with your form.
Meter Reading(s) Date

MonthDayYear
Date
Main Meter Reading
Outside Remote Reading Device (if possible)
Sub-meter Reading (if applicable)
Outside Remote Reading Device (if possible)
Dispute Information
*Disputed Billing Period(s):
*WSSC will not accept any DRB Review Request Forms for bills generated more than 60 days of the meter reading date upon which the bill was based.
Please thoroughly explain your reason for disputing the bill(s) (include all information/documentation pertinent to your dispute)
*Disputed unpaid portion of the bill(s)
*WSSC's fees are required by Maryland law; therefore, this amount should not equal 100% of the billed charges. Additionally, if the property was occupied during the period and water was used, this amount should not equal 100% of the water/sewer charges.
# of people living at the property during the disputed period(s)
# of people living at the property one year before the disputed period(s)
# of people living at the property currently
Should be Empty:

Dispute Resolving Board (DRB) Review Request Form

Customer Information

Meter Readings

Dispute Information