Leak Adjustment Form

2. Disclaimer: I understand a leak credit is a courtesy and will not cover the full amount of the water bill nor the cost of the repair. The repair must be made prior to requesting a credit (turning off the water supply does not qualify as a repair). Credits are limited to one per address in a 12-month period. Please allow 10 business days for the account to reflect the adjustment. By clicking “submit”, you agree to this disclaimer.
4. Service Street Address*
6. Account Holder Name*
8. Phone*
9. Email*
11. Type of Leak*

    Check all that apply

    1. Inside Leak
    2. Irrigation
    3. Outside Service Line
12. Date Leak Repaired*
    Date Leak Repaired
13. Leak Repaired By:*

    1. Self
    2. Contractor
15. Part Purchased*
16. Store Name*
18. Name of Contractor*
19. Attach Invoice / Receipt*
21. Meter Usage (in thousands of gallons) from current high water bill*
22. Meter Usage (in thousands of gallons) from same month of previous year.*
24. Current usage three times (3x) greater than the prior year?
    • Yes <ul><li> Inside Leak = $25</li> <li> Irrigation = $75 </li> <li> Outside Service Line = $150</li></ul> • No <ul><li> No leak credit available </li></ul>

    • Yes

    • Inside Leak = $25
    • Irrigation = $75
    • Outside Service Line = $150

    • No

    • No leak credit available
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field