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2. To receive a credit on your sewer service charges
   Please complete this form If you experienced an in-home water leak, (due to a broken pipe or meter damage) please use this form to provide as much information as possible, to help justify a bill adjustment.
   
   The information you provide will be used to verify that your water usage has returned to normal.
4. Please Note:
   For water leaks that do not enter the sewer system, usage will be reviewed up to 1 year prior to the break being repaired. This only applies to excessive flow amounts within the period exceeding normal average daily flow for the property. Credits will be limited to 50% of the current sewer rate.
6. Name, as it appears on your Sewer and Water bill:*
8. Account number (from your bill statement)*
9. Email Address*
10. Phone number, where we may reach you*
12. Service Address*
14. Billing Address, if this is different from the service address.
16. Date(s) of event(s)*
    When was the leak discovered? If this occurred more than once, please list all dates.
17. Was your Water Meter turned off?

    1. Yes
    2. No
19. Please describe what happened.
    How was the leak discovered? Was it due to a plumbing failure? A burst pipe? Did the leak occur before or after the Water Meter? Was the Meter damaged?
21. Have repairs been made?

    1. Yes, by a plumber
    2. Yes, by homeowner/landlord
    3. No, repairs are incomplete
22. If repairs were made by a plumber, please give the company or individual's name
24. Additional Comments:
26. Bill Credit
    Please allow 1-2 bill cycles for a credit to be posted to your account. This allows us to compare water meter readings and ensure that your consumption has returned to normal.
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field