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e e PLEASE CHECK: o OWNER CHANGE OR o NAME CHANGE AND/OR ADDRESS CHANGE ONLY PLEASE INDICATE ADDRESS CHANGE BELOW: PAYMENT INFORMATION Detach payment coupon from top of form and return with payment in the envelope enclosed. Your check, certified check or money order should be made payable to the Texas Water Commission. Please include your account number on your check to ensure that payment is properly credited. If you think your bill is wrong, or if you need more information about a transaction, please address your questions to: Texas Water Commission Fiscal Services Section P,O, Box 13087 Austin, Texas 78711-3087 In your correspondence, please give us the following information: 1. Your name and account number 2. The dollar amount of the suspected error 3, The date and reference number of the transaction(s) in question 4, Description of the suspected error Written notice of a billing error must be received within 45 days of the date of the billing statement. Prompt payment must be made for any part of the bill not in question, The collection of disputed charges and the accrual of interest and penalities will be suspended until we have resolved the suspected error or explained the assessments which are due. The suspension of charges and penalties cannot be guaranteed without written notice, however, you may telephone the Texas Water Commission if there is a problem with your bill: Water Quality Assessment Billing Information ,................,....,.................................,.........,........... 512/463-8267 EXPLANATION OF CHARGES The basis for each charge is identified by the facility, permit. application or other appropriate activity to which a charge may be applied. The state fiscal year (FY) and the quarter of the year (QTR) to which the payment will be credited are shown where applicable. Current statutes may prescribe penalties regarding delinquent payments. PREVIOUS BALANCE is the amount which was billed in your last statement. PAYMENTS AND CREDITS are items which have been credited to the previous balance due. CHARGES AND ADJUSTMENTS are the current items being billed in this statement. LA TE FEES are charges applied to an unpaid balance for late payment. LPS Form AR4OC1 (Rev, 02-20-92)