Fillable 78 Request For Water Leak Adjustment Form (City of Cibolo)

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78 Request For Water Leak Adjustment Form (City of Cibolo)

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The 78 Request For Water Leak Adjustment Form (City of Cibolo) form is 1 page long and contains:

2 signatures
8 check-boxes
12 other fields

Country of origin: US
File type: PDF

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Request for Water Billing Adjustment

ity of Cibolo 200 South Main / PO BOX 826 Cibolo, Texas 78108 (210) 658-9900 www.cibolotx.gov

*We also reserve the right to make adjustments based on your historic usage.

*Please have copy of repair bill or receipts from purchase of items to repair leak attached.

Office Use: Approved Denied ____________________________________

Please read and acknowledge each item below by checking the box and signing:

____ Adjustments for unexplained high consumption will be considered when consumption exceeds

200% of historical usage.

____ Adjustments will be processed after evidence of repair is reflected by reduced consumption in the

following billing period.

____ The customer will be required to pay an amount equal to the most recent undisputed billed

amount by the due date, pending the adjustment calculation.

____ Adjustment calculation will consider customer average consumption for the same time period for

the prior two (2) years (or other relevant time period if that data doesn’t exist). Consumption in

excess of the average will be billed at a reduced rate of 50% of the resident’s average tier in the

applicable rate schedule.

____ Only one abatement will be granted in a 6 month period.

____ Adjustments under $25.00 will not be processed.

ignature: __________________________________________________

Name:

Date:

Address:

Contact #:

Location of Leak: ___ Inside

___ Outside

Account #:

Date of Repair:

Receipt Attached:

Describe Situation or Repairs Made:

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