| NES Utility Bill Record |
National Exemption Service (NES) Corporate: 100 S Belcher Clearwater Florida Rd Safety Harbor, FL 34695 |
Mailing: P.O. Box 926, Safety Harbor, FL 34695-0926 President: Mr. Gerald Baker |
NES LOGO | |
| Account No. | Meter No. | Service Address | Billing From | Billing To | Cycle Range | Check Memo | Total Balance |
|---|---|---|---|---|---|---|---|
| Section | Topic | Requirement | NES Response | Days | Policy Ref | Status | Notes | ||
|---|---|---|---|---|---|---|---|---|---|
| Description | Detail | Date | Handler | ||||||
| Targeted Billing Clarification Inquiries | Ref | |
|---|---|---|
| 3. Error Resolution Procedure — misposted payments, duplicate late fees, correction timeline and confirmation process. | ||
| Formal Correspondence Summary | Status |
|---|---|
| Formal billing dispute lodged with NES Billing Manager; NES must identify responsible individual and provide written response timeline. |
| Invoice — Itemized Overcharge Assessment | ||||
|---|---|---|---|---|
| Description | Quantity | Unit Cost ($) | Line Total ($) | Notes |
| TOTAL BALANCE DUE | ||||
| Certification & Digital Signature | ||||
|---|---|---|---|---|
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| Late Fee Overcharge Assessment Invoice | ||||
|---|---|---|---|---|
| Description | Quantity | Unit Cost ($) | Line Total ($) | Section |
| TOTAL BALANCE DUE | ||||
| REGULATORY COMPLIANCE NOTICE |
| Addenda – Supporting Documentation | ||
|---|---|---|
| Evidence ID | Date | Description / Reference |
| Pay To |
Account Number |
Amount Due |
Authorized Signature |
Notary / Witness |
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Billing Information |
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