Leak Adjustment Request

2. 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. Once your request has been received, it may take up to six (6) weeks before the request is approved or denied.
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:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field