Leak Adjustment Request Form

PLEASE NOTE: Completion of this request does not guarantee an adjustment will be made to your bill. Please allow 3-6 weeks to process. We will contact you once the review is complete. Why the delay? Adjustment Requests are reviewed after the affected period has been billed.

All fields with an asterisk * are required.

CUSTOMER INFORMATION
LEAK REPAIR INFORMATION
This could be a copy of plumber’s bills, receipts for parts, or pictures & additional information as to why receipts were not obtained for the repair of the leak.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
This could be a copy of plumber’s bills, receipts for parts, or pictures & additional information as to why receipts were not obtained for the repair of the leak.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
This could be a copy of plumber’s bills, receipts for parts, or pictures & additional information as to why receipts were not obtained for the repair of the leak.
Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
AGREEMENT TO COMPLY WITH TERMS OF SERVICE

Electronic signature agreement. By selecting the "I Accept" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

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