3029W (4/15/01)

(Filling this form out is in accordance with s. 196.26(1) Wis. Stats.) Personally identifiable information collected will not be used for any other purpose.

Our web-based Purchased Water Adjustment Clause application offers you the ability to file for a water adjustment based on a rate increase from your wholesale supplier. This application is designed to provide you with a flexible method for submitting PWAC information in an efficient and timely manner.

Items to note:
	A utility must request the Public Service Commission of Wisconsin (PSCW) to authorize a PWAC change within 90 days of a change in its wholesale supplier's rates or forfeit all adjustments to its rates under the PWAC until the time of its next rate case.
	You will not be able to use this program if you purchase water from two or more wholesalers.
	You have 14 days to complete this application. After 14 calendar days, your application may be deleted.
	When providing information, remember to check the accuracy of your information.
	If you need to supply additional information, you can fax the materials to "Attention PSCW Water Staff" at (608) 266-3957.

If you have any questions about the content of the application, please contact David Prochaska by e-mail at David.Prochaska@psc.state.wi.us or by phone at (608) 266-5739.