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Water Review Board Request

Name *

Address of Property *

Account Number

City *

Zip Code *

Daytime Phone Number *

Email Address

Reason for Request *

Eligibility Checklist (Customer MUST meet ALL criteria) *

Received shut-off/termination notice

Person completing this form is financially responsible for bill

Current date is within 10 days of receipt of shut-off/termination notice

Proof of residency for the disputed bill period is attached

Proof of Residency (Required for Tenant Requests)

Files must be less than 2 MB.
Allowed file types: jpg jpeg png pdf doc docx.

Residential Account (Non-Commercial*) *

*Multi-family dwellings with more than 4 units are considered commercial and do not qualify

Owner of dwelling with 4 or less units

Tenant consumer who has signed an agreement with Cleveland Water and who has paid the required deposit

I am the owner/tenant of the above referenced property, and request a hearing before the Water Review Board concerning the contested outstanding balance on this account.

Please Note:

Prior to scheduling a Water Review Board hearing an investigation may be scheduled. You will be notified to schedule the investigation appointment, which may take up to two weeks. Your account will be placed on hold from any collections activities until your case is heard before the Board.

If you have any questions please contact Customer Service at (216) 664-3130.

PROPERTY OWNER/TENANT E-SIGNATURE: *