Form Center

2. Account Holder Information
4. First Name*
5. Last Name*
7. Service Address*
9. City
10. State
11. Zip
13. Utility Account Number*
    (Enter with dashes, i.e. xx-xxxx-xx)
14. Phone Number*
    (Enter with dashes, i.e. 972-292-5000)
15. Email Address*
19. Leak Information
21. Upload Receipt (PDF or JPG Preferred)*
22. Leak Detection Date*
23. Leak Repair Date*
25. Repaired By:*
27. Brief Explanation*
29. Disclaimer
    I understand that this Partial Leak Credit will be granted once every 12 consecutive months. This request will not be considered until after the repair has been completed and the meter has been read for the period following the leak repair. Further, I understand that only two of the highest billed consumption affected by the leak will be evaluated and that I must continue to make payments on my account equivalent to my normal monthly bill for the months affected by the leak. Additionally, I must pay all current monthly charges after the leak is repaired. I understand that failure to maintain these minimum monthly payments will forfeit my eligibility for a partial leak credit and subject the water to service interruption without further notice. Finally, whether or not a credit is processed, I take full responsibility for paying all remaining charges. Please allow 4 - 6 weeks for the partial leak credit to be processed. By clicking 'submit', you agree to the above disclaimer.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field