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2. 
3. Utility Billing Department
   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.

   
   

   The request for this adjustment must be made within 4 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:*
27. Today's Date*
    Today's Date
Leave This Blank:


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

    This field is not part of the form submission.

31. Submit

* indicates a required field