Form Center

Request Water Leak Credit

2. 

3. Utility Billing Department
   Request Water Leak Credit

   Request Water Leak Credit

5. Customers who have experienced a water loss due to one of the following reasons may request an adjustment to their account. <br> <br> The request for this adjustment must be made within 6 months of the repair date.

   Customers who have experienced a water loss due to one of the following reasons may request an adjustment to their account.
   
   The request for this adjustment must be made within 6 months of the repair date.

7. Date Leak Found*
   Date Leak Found

8. Date Leak Fixed*
   Date Leak Fixed

10. Where was your leak?*
    -- Select One --UndergroundBehind a wallIn the slabOther

12. Describe the location and discovery of the leak*

14. What course of action was taken to repair the leak?*

16. Please attach a copy of plumbing receipt, invoice when it was fixed, or personal store receipts.*

18. Name*

19. Account Number*

21. Service Address*

23. Phone #*

24. Email Address*

26. Customer Signature:*

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field