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Please also forward a second copy of the dispute form to: - page 5 / 7

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5 / 7

SECTION II – BILLING DATES

In order to process your dispute for SECTION II – BILLING DATES you will be required to answer all questions in this section and send in the following documents:

  • Acceptable Proof of Residency is required. (See page 5)

    • 1.

      What is the address you are disputing? (house number, street, city, zip code)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

2.

What dates did you reside at or own the disputed address?

From

To

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_____________________________________

3.

Did you call National Grid to disconnect service? If so, on what date did you call to have services disconnected

at the disputed address? (Month/Day/Year).

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

4.

What telephone number did you call from to request disconnection of service? (Please include area code).

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

5.

At the time of your disconnect, did you request a connect for new services at another National Grid address?

Yes F

No F

If yes, at what address? (house number, street, city, zip code)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

SECTION III – BILL PAID

In order to process your dispute for SECTION III – BILL PAID you will be required to answer all questions in this section and send in the following documents:

  • A copy of the Cancelled Check is required (see page 5)

    • 1.

      What is the address you are disputing? (house number, street, city, zip code) _______________________________________________________________________________

    • 2.

      Please tell us where, when, and to whom the payment was made. _____________________________________________________________________________

4 FINAL+BILL+DISPUTE+FORM+KEYSPAN+(3)[1].DOC

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