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LEAK ADJUSTMENT REQUEST FORM

  1. Electronic Signature Agreement*

    By signing this online form, I/we are agreeing that the information provided by I/we is correct and now the repair is in good working condition. 

    In my opinion these leaks were large enough to have caused the increase in the water bill rendered to the above address. I make an oath the statement above is true and correct. 

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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