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2. Service Address*
3. Account Number*
4. Zone
6. Name on Account*
8. INFORMATION ABOUT THE LEAK
10. Approximate Date of the Leak*
    Approximate Date of the Leak
11. Location of the Leak*
13. Who made the repair?*

    1. Plumber
    2. Self Repaired
15. LEAK ADJUSTMENT GUIDELINES
17. Guidelines
    A hidden leak shall be defined as a leak that cannot be detected until a higher than normal water bill is received. A hidden leak includes water leaks in the interior plumbing of a structure such as walls, slabs, in sprinkler system heads, and other undetectable areas. A hidden leak is not defined as a leak in hot water heaters, toilets, dripping faucets or frozen plumbing. In the event of a hidden leak, the City shall share the cost up to a maximum of $150.00 of the excess water attributable to the hidden leak that has passed through the meter.
19. A leak adjustment will be made:

    a. Only once a calendar year.

    b. Only after proof has been received that the leak has been repaired. (invoice from licensed plumber or letter from homeowner with receipts attached)

    c. Only to the highest month consumption affected by the leak

21. Invoice or Letter*
23. Receipt
25. Receipt
29. 1. The amount of adjustment, not to exceed $150.00, determined by the following formula:

    a. Calculate the amount of “normal” consumption.

    b. Averaging the previous 6 months before the leak occurred; or

    c. Using volume from same month of the previous year, whichever is greater

    d. Subtract calculated “normal” consumption from actual consumption.

    e. Divide the difference by 2

    f. Apply the rate to the result in subsection (e)

    g. The resulting dollar amount, up to $150.00, shall be the amount of the credit to the customer’s account.

31. 2. Customer costs associated with the leak repair are not reimbursable by the City. The City will only assist with the cost of excess water flowing through the meter, as a result of a hidden leak

    By signing, I hereby do affirm that the above statements are true and correct. If any information is found to be false and/or misleading, the leak adjustment may be denied and/or any credit adjustment posted to my account, as a result of approval of this request, may be forfeited. Processing may take a month to be resolved until consumption returns to normal, during which time the account must remain in good standing with any/all outstanding balances paid in full (including penalties) by their respective due dates. If your account(s) is not in good standing, your request will be subject to immediate denial.

33. Electronic Signature of Account Holder*
    Please type your First and Last Name
35. Agreement*

    1. I understand that checking this box and typing my First and Last Name above constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
37. Office Use Only
39. Approved/Amt of Credit: __________________________________________________
41. Denied/Reason: __________________________________________________________
43. Completed by: _____________________________
44. Signed off by: _______________________________________
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46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

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