Landis, NC · Rowan County
Request for Adjustment
Customers use this form to request an adjustment to a utility account and explain the reason for the request.
What this form is
The form lets a customer request an adjustment by providing account and service information, explaining the request, and recording the repair date. It states that proof of repair is required and that adjustments are limited to a maximum of 30 days prior to proof of repair. It also says adjustments are not approved for continuous-running commodes or water that has run through the Town’s sewer lines.
Who needs it
A customer seeking an adjustment to a utility account can use this form to explain the request and provide repair information.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; attach proof of repair, and the requestor signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Request for Adjustment PDF.
- 2
Complete The Form
Enter customer and account details, explain the adjustment request, and provide the repair date.
- 3
Gather Proof Of Repair
Include proof of repair, which the form says is required for an adjustment.
- 4
Sign And Submit
Sign and date the form, then submit it to the city department named on the form.
Frequently asked questions
- Do I need a notary for the Request for Adjustment?
- No. The form has a requestor signature and date line, but no notary block. Include proof of repair; the requestor signs and dates the form.
- What information does the Request for Adjustment ask for?
- It asks for the customer name, account number, service and mailing addresses, an explanation for the adjustment, and the date of repair.
- What proof is needed for an adjustment?
- The form states that adjustments will not be made without proof of repair. It limits adjustments to a maximum of 30 days prior to proof of repair.
- How do I submit the Request for Adjustment?
- Submit it to the city department named on the form; check the city website for current contact details.