REQUEST FOR LEAK ADJUSTMENT

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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. In order to qualify for I, request an adjustment be made to my water account, Account Number due to my having a water leak. My bill meets the criteria stated above which qualifies me for the adjustment per Limestone County Water & the leak was located select one .

Today's Date:

Service Address*:

Telephone Number*:

Email:

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.

Customer Signature (I accept):