The City of Washington, Indiana

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Request for Water/Sewer Adjustment for Water Leaks

About this Form

To request an adjustment for a water leak, please complete the form below.

For additional information or questions on this form, contact Anita Ash.

* Denotes a required field

Contact Information

Phone Number
-- ext

Service Information

Date Leak Discovered
 , 
Date Leak Repaired
 , 
PLEASE NOTE: Completion of this form does not guarantee adjustment will be made to your bill. All adjustments are issued based on average usage for previous account history and are credited on your bill. Once the review is complete, you will receive notification of results from the Utility Billing Office. We cannot guarantee approval/disapproval on current bill.
By checking this box you acknowledge that:
I have read, understand, and agree with the leak adjustment guidelines:*
Note: In order to receive this adjustment, we need the signature of both parties (landlord and tenant) if applicable to complete this application. To complete this request, either print, sign, and attach documents to this request; print, sign, and fax documents to 812.254.8200; visit one of our locations to finish, or submit the request, sign, and mail documents to Washington Municipal Utilities, P.O. Box 800, Washington, IN 47501.)
Please Click Submit when Finished.
City Hall: 101 N.E. Third Street - Mayor's Office: 200 Harned Avenue
Washington, IN 47501

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