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Request for Qualifications (RFQ) Document Access Forms
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Leak Adjustment Form
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Step One
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Step Two
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Step Three
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Step Four
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Step One
Leak Adjustment Guidelines
SqCWD will grant an Adjustment for any leak, or unexplained high water use.
Adjustments must be applied for within ninety (90) days of the billing period in which the high water use occurred.
The amount of the adjustment is determined by comparing consumption during the period of the high usage to the same period the prior year. It is assumed that the difference in use is is attributable to a leak or other unintentional usage. Fifty (50) percent of the excess water use, caused by the incident, is excused. The remaining fifty (50) percent is billed at the highest billing tier the customer attained for the same period the prior year.
A maximum of two (2) consecutive billing periods can be considered for qualifying adjustments.
Customers are allowed one adjustment every three years.
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Step Two
Name
Account Number
Address
City
State
Zip Code
Phone Number
Email Address
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Step Three
In order to process your application quickly and efficiently, please give a complete and clear description of the leak or unintentional high use. Include the type of leak, how it was repaired, and the date of repair. If the usage was unintentional, please provide a description of the circumstances. Attach repair bills and/or invoices.
Leak Type
*
-- Select One --
Hose
Indoor
Irrigation
Service Line
Toilet
Unexplained
Other
Repair Bills and/or Receipts
Please upload repair bill or receipt
Repair Date
*
Repair Date
Description of Leak & Repair or Unintentional Usage
*
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Step Four
As the customer for the above listed service address, I hereby apply for and accept a billing adjustment, to be applied as a credit to my account, under the SqCWD Leak Adjustment Program. I have read, understand, and accept the above adjustment policy guidelines, listed above, and certify that all information submitted is accurate and true.
Electronic Signature Agreement
*
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.
I agree.
Electronic Signature
*
Date
*
Date
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