CUSTOMER SERVICE CENTER ACTION REQUEST FORM

Provide the business name if the request is regarding a business.

Phone Number

This request is regarding the following:

Please provide the 8-digit Account Number

Please provide the Business License Number

Please provide the Burglar Alarm Permit Number

This request is regarding the following:

It is the customer’s responsibility to monitor water usage by reviewing their monthly billing statement. Leak adjustments do not remove water usage from your bill. The leak must be repaired before an adjustment will be considered.

Charges for water usage are not wavied, but may be billed at a lower rate tier.

Request for an adjustment must be made within sixty (60) days of the first bill reflecting high consumption due to a leak. The period requested for an adjustment must not exceed two (2) consecutive months. One (1) adjustment is allowed per customer, per location, over the life of the account.

Commercial customers will not see a reduction in water cost, but reduction in sewer charges may be possible.

Date Leak was Repaired

Please provide all relevant information for your request. You will also have the option of attaching documents before submitting the form.

Upload any documents you wish to submit with the request.

Click Here to Upload

Under penalty of perjury, I swear or affirm the above statements are true to the best of my knowledge.

Yes

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.