Request for Leak Adjustment

Today's Date *

Customer Name (as appears on bill) *

Account Number

Service Address *

Location of Leak (toilet, underground, etc.) *

Phone Number *

Email Address *

If a customer has a leak and the usage is 3 times more than the past past 12 month average, usage above the 12 month average will be billed at the commercial rate. Each customer is allowed only one leak adjustment each 12 month period. I understand and sign below that I cannot receive another leak adjustment to my account for a period of one (1) year from the date the customer service manager approves this adjustment. *I accept these terms.

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Our Location

17218 US Highway 72
Athens, AL 35611

PO Box 110
Athens, AL 35612

256-233-6444

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