Utility Billing Adjustment Requrest Form

Water Service Address: *

Mailing Address (if different from above):

Account Number:
Phone Number: *

Area Code Phone Number
E-mail: *
The above service address had unusually high water use due to (check all that apply): *

Service Line Leak Irrigation Leak
Please explain the nature of the problem that has caused the high water usage: *
Please attach documentation that the leak/problem has been fixed.
Additional documentation (if needed)
Additional documentation (if needed)
Should be Empty:

Utility Billing Adjustment Committee Form