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Leak Adjustment Request Form
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Leak Adjustment Request Form
Please complete this form if you have repaired a leak, and would like to request an adjustment on your bill.
Service Address
*
Property Owner's Name
*
Person Requesting Adjustment
*
Mailing Address
*
Telephone
*
Email
*
Billing Period of Requested Adjustment
*
One 60-day billing cycle
When Was Leak Discovered?
*
When Was Leak Discovered?
When Was Leak Repaired?
*
When Was Leak Repaired?
The leak must be repaired before requesting a bill adjustment.
Details of Location of Leak
*
Please be as specific as possible.
Repair Bills
Upload copies of any repair bills or receipts for parts.
If unable to scan and upload documents, check this box to acknowledge that you will hand deliver or mail paper copies of required documentation.
I will provide paper copies.
Once we receive this request, it will be reviewed and you will receive notification of any available adjustment. Once you have authorized the adjustment, the credit to your account will be processed.
Please contact the office if you have any questions 425-355-3355.
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