Leak Adjustment Request

2. Leak adjustments are given for <strong>sewer charges only</strong> on qualifying leaks where proof of repair is provided. Toilet leaks do not qualify. Customers are eligible for one leak adjustment every three years. We will respond to your request within three business days.

   Leak adjustments are given for sewer charges only on qualifying leaks where proof of repair is provided. Toilet leaks do not qualify. Customers are eligible for one leak adjustment every three years. We will respond to your request within three business days.

4. Name of Account Holder*

5. Account Number

7. Service Address*

9. Address2

11. City*

12. State*

13. Zip*

15. Email Address

16. Phone

18. Please describe the leak and repair, including dates.*

    Adjustments are *not* given for toilet leaks.

20. Proof of Leak Repair*

    Please submit a copy of the receipt for plumber services or purchase of repair supplies. Proof of leak repair is required for a leak adjustment.

22. Date Received
    Date Received

    Date Received

    For Internal Use Only

Leave This Blank:


23. 1. Receive email copy
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field