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2. Customer Name*
4. Service Address*
6. Account Number*
8. Meter Number*
10. Meter Read Date*
    Meter Read Date
12. Self Read Meter Read*
14. Please read below and click on the checkbox*

    1. By checking this box, I hereby certify that the information provided in this submission is accurate. I understand that providing false or misleading information may result in disqualification, penalties, or other corrective actions as determined by Alameda County Water District. Any discrepancies will be my responsibility and cannot be disputed.
16. Upload a picture of the Meter with the Read (optional)
18. Sample Read: “0002”. Only enter underlined numbers.
    
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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