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2. Leak Adjustment Request Form
   Please complete this form if you have repaired a leak, and would like to request an adjustment on your bill.
4. Service Address*
6. Property Owner's Name*
8. Person Requesting Adjustment*
10. Mailing Address*
12. Telephone*
13. Email*
15. Billing Period of Requested Adjustment*
    One 60-day billing cycle
16. When Was Leak Discovered?*
    When Was Leak Discovered?
17. When Was Leak Repaired?*
    When Was Leak Repaired?
    The leak must be repaired before requesting a bill adjustment.
19. Details of Location of Leak*
    Please be as specific as possible.
21. Repair Bills
    Upload copies of any repair bills or receipts for parts.
23. If unable to scan and upload documents, check this box to acknowledge that you will hand deliver or mail paper copies of required documentation.

    1. I will provide paper copies.
25. 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.
Leave This Blank:


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

    This field is not part of the form submission.

29. Submit

* indicates a required field