Claim Form - Water

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Claim Form - Water

Please find below the claim form for water complaints.
(All form fields are mandatory)

Name

Address

Phone nr at home or cell

Phone nr at home or cell :: In order to deal with your complaint rapidly, it is important for Aqualectra to have the telephone number where you can be reached during office hours.

Phone nr at work

E-mail address

Meter number

Failure details

Date of the failure

Date of the failure :: Without the date and the time of the failure, Aqualectra distribution can not deal with the problem.

Time of the failure

Time of the failure :: Without the date and the time of the failure, Aqualectra distribution can not deal with the problem.

Date of filing the complaint

Description of the failure

Other damaged appliance

For questions, please call Cunningham Lindsey at 7270733

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