Application for Leak Adjustment

This leak adjustment application MUST be filled out COMPLETELY and received at the Utility Accounting office (Room 106) in City Hall within 3 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.

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*Account #: Account# is Required

*Account Name: Account Name is Required

*Address: Address is Required

Phone #: Phone # Required Enter Phone Format (###) ###-####

Email: Enter valid Email Address

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Date leak was repaired: Leak Repaired Date is Required Invalid Format. Use MM/DD/YYYY

Type of leak or repair: Type of Leak is Required

Do you know how long the leak was going on? : Length of Leak is Required

Where did the water go? (exp down drain): Where did the water go? is Required

Who did the repair?: Who did the repair? is Required

Number of people living here?: Number of people is Required

Any water changes in the last year or going forward for the next month?: Water Changes is Required
(exp: occupancy, water savers installed, watering)

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