Billing + Payments

Leak Adjustment Request Form

Customers that present proof that a leak was repaired may be eligible for a concealed leak adjustment. The ordinance allows Customer Service to consider such a bill adjustment once every 12 months. The department may be able to lower a customer's water bill based on the information provided.
If a concealed leak caused your water bill to rise and the leak was recently repaired, complete the form below for consideration.

Account Name

First Name *

Middle Initial

Last Name *

Account Number *

Service Address

Address Line One *

Address Line Two

City *

State *

Zip *

Phone Number *

Email Address

Receipt for Plumbing Repairs *

. jpg , .pdf

Comments

Signature

Today's Date *

Policies

I, the undersigned, experienced a leak at the above service address that resulted in my water consumption being more than 20% higher than my normal water consumption. I have had the leak repaired, as evidenced by the attached receipt, and am requesting an adjustment to my account. Additionally, please check the sewer calculation to determine if the leak effected my consumption during the months used to calculate the sewer charge. If so, please adjust the sewer charge accordingly.I understand that this request will not be considered until after the meter is read for the period following the leak repair. Further, I understand that only the two highest months effected by the leak will be adjusted and that I must make payments on my account equivalent to my normal monthly bill for months effected by the leak and must pay all current monthly charges once the leak as been repaired regardless of whether or not an adjustment has been granted.

I have read and agree to the

Billing + Payments

Leak Adjustment Request Form

Irving City Hall

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