Leak Adjustment Application

Leak Adjustment Application
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Please Carefully Read the Following Information:
- Completion of this request does not guarantee an adjustment will be made to your bill. The account must remain active to receive an adjustment and to avoid additional service charges.
- Please allow 2-4 weeks after the next month billing cycle. If you do not see the adjustment after this time frame, please email the office at ub@cityofjosephinetx.com.
- Please note that the current balance is still due in full, unless you contact the utility billing department regarding a payment arrangement pending the leak adjustment.
- All customers must be signed up for mywateradvisor2.com in order to receive any leak adjustments.
- All customers must submit proof of repairs - a request without proof will be uneligable for an adjustment.
  - Ex: Plumber's invoice, receipts for parts, pictures showing the leak is no longer active.
- Only 1 adjustment will be granted within a 12 month period.
- This adjustment will help with the excess cost, not eliminate it. This means the adjustment could potentially leave a balance higher than a customer’s average bill.
I acknowledge that I have read and agree to the above statement.*

Yes
Customer Details:
Full Name*

First NameLast Name
Account Number*
X-XXXX-XX
Service Address*

Street Address

CityState

Zip Code
Phone Number*
E-mail*
example@example.com
Leak Information:
Date leak was discovered*

MonthDayYear
Date
Type of adjustment requesting:*

Broken pipeToilet leakOther
If selected other please specify:
Leak Repair Information:
Date leak was repaired*

MonthDayYear
Date
Location of the leak*
Description of repairs made to fix the leak*
Please attach any/all proof of the repairs made for the leak. *

Ex: Plumber's invoice, receipts for parts, pictures showing the leak is no longer active.
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Leak Adjustment Application

My Water Advisor 2.0