Application for Leak Adjustment

This leak adjustment application MUST be filled out COMPLETELY and received at the Utility Billing office (Room 106) in City Hall within three months of the repair to be considered for a leak adjustment credit. The credit will only apply to the last three billing periods ending with the repair date.

Account #*

Account Name*

Phone #*

Address*

Date leak was repaired

Do you know how long the leak was going on?

Who did the repair?

Type of leak or repair

Where did the water go? (exp down drain)

Number of people living here?

Any water changes in the last year or going forward for the next month?

(exp: occupancy, water savers installed, watering)