Water/Sewer Bill Adjustment Request Form

OFFICE USE ONLY: Standard Credit Total
OFFICE USE ONLY: Special Exception Credit Total
WATER/SEWER BILL ADJUSTMENT

Introduction: Section 1 of 3
We're sorry you had trouble!

If you experienced a water leak on your property impacting a recent utility bill, please read below and complete the form, so we can see if you are eligible for a bill adjustment.
Before you begin...
- Receipts/invoices showing proof of the repair are required. Please have these available when completing this form.
- The single highest water/wastewater monthly bill compared to the average of your prior 12 months of billing determines any potential bill credits.
- Requests must be submitted within 90 days of the meter reading date printed on the monthly statement.
- Payment equivalent to a normal usage bill may be required to maintain an account in good standing during the review process.
- Swimming pool fills may be eligible for a sewer credit only.

WATER/SEWER BILL ADJUSTMENT

Form Data : Section 2 of 3
Help us find your account...
ResidentialNon-residential
Customer*
Name as it appears on the utility bill
Service location*

Street address (include unit number, if applicable)

Street Address Line 2

City, StateZip

Postal / Zip Code
BVU account #
Phone number*

Area CodePhone Number
Email
example@example.com
Water leakSwimming pool fill
Tell us about your water leak...
IndoorOutdoors
Leak start date

MonthDayYear
Approximate date or leave blank if unknown
Leak repair date*

MonthDayYear
Approximate date if necessary
Proof of repair*

Browse Files
Acceptable documents: repair invoice (if repaired professionally) or materials receipts (if self-repaired) Cancelof
Tell us about your pool...
Pool fill start date

MonthDayYear
Approximate date or leave blank if unknown
Pool size
Approximate gallons or leave blank if unknown
Additional notes?
Please share any additional details you wish.

WATER/SEWER BILL ADJUSTMENT