POOL FILL ADJUSTMENT
REQUEST FORM
General Guidelines
Effective May 8, 2012, the Orange County Board of County Commissioners approved Resolution No. 2012-M-11 titled,
“Billing Adjustments For Excessive Water Consumption,” which states in part that all customers with 5/8 x 3/4 inch meters
and all residential customers regardless of meter size who experience unusually high water usage with a corresponding
spike in their monthly water bill may be considered for a billing adjustment after completing this form within 60 days of the
date of the unusually high consumption, submittal of the requested documentation described below and investigation and
verification by Orange County Utilities staff. Please complete this form in its entirety and return to Orange County Utilities
for processing.
Pool Fill Guidelines
• Adjustment is available no more than once annually.
• Adjustment is available only for wastewater portion of the bill.
• The customer’s prior 12-month average usage will be used to calculate the wastewater charges for the high water
b
ill month in question.
• No adjustment is available for water charges and applicable tiered rate structure shall apply.
• Customer must submit a copy of the repair invoice/payment receipt from company performing the pool
work that requires pool fill. The repair invoice/payment receipt should include the address of the pool
location, the date of the repair, the pool dimensions, and the date and amount of water used to fill the pool.
1) All customers requesting a billing adjustment in accordance with these guidelines are required to pay their bill in
full or make payment arrangements while this form is being processed.
2) For customers with less than 12-months water usage, Utilities staff will estimate 12 months of usage.
Customer Information
Name: _______________________________________ Account #: ______________ Telephone #: ___________________
Service Address: _______________________________ Mailing Address: _______________________________________
Pool Fill Information
Reason for Pool Fill: New Pool Pool Repair Date Pool was Filled: ____________
Number of Gallons Used to Fill Pool: ___________ Please Provide Brief Explanation of Repairs Below:
Please Sign and Date Below
Customer Signature: ___________________________ Date: _________________ Email: __________________________
Please send to Orange County Utilities, 9150 Curry Ford Rd., Orlando, FL 32825-7600; fax to 407-254-9697; or email the
scanned, completed form to Adjustment.Request@ocfl.net. Telephone: 407-836-5515 Website: www.ocfl.net/utilities/
Para más información, por favor llame al Departamento de Servicios Públicos del Condado de Orange y pida hablar con un representante
en español. El número de teléfono es 407-836-5515.
Rev. 3/18
