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Request for Water/Sewer Adjustment for Water Leaks
Request for Water/Sewer Adjustment for Water Leaks
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To request an adjustment for a water leak, please complete the form below.
*
Denotes a required field
Contact Information
Name
*
Phone Number
*
Phone Area Code
-
Phone 3
-
Phone 4
ext
Extension
Email
*
Please Do Not Complete The Following Field
Service Information
Account Number
*
Name on the Account
*
Service Address
*
Type of Adjustment Requested
*
50% Adjustment Sewer (once per year)
50% Adjustment Water and 100% Sewer (once per history of ownership of property)
100% Adjustment Sewer (once per history of ownership of property)
100% Adjustment Water (once per history of ownership of property)
100% Adjustment Water and Sewer (once per history of ownership of property)
Date Leak Discovered
*
Month
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Year
,
Date Leak Repaired
*
Month
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Jan
Feb
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Day
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Year
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Description of Leak
*
Repaired By:
*
Contractor
Customer
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:*
*
I Agree
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.