Elyria City Hall
131 Court Street, Suite 102
Elyria, Ohio 44035
Phone: (440) 326-1570 Fax: 440-326-1588
In the event of a documented loss of water due to a leak or other unforeseen circumstance on the customer side of the meter,
resulting in more than the average consumption for the account, the customer may apply for a credit.
A Credit may be given under the following conditions:
(a) Proof of the repairs has been presented within ten (10) business days.
(b) The account holder has reported the leak to the Utilities Office on the water leak credit form.
(c) The account holder presents proof of such loss to the satisfaction of the City, with a brief
description of leak and repair done. (Provide on back of Form).
(d) A credit has not been rendered within the past two (2) years.
SERVICE ADDRESS: _______________________________________________________________________________________
(Street Address) (City, State and Zip code)
ACCOUNT HOLDER (NAME):_______________________________________________________________________________
(Last Name, First Name, OR Business Name)
Please select one of the following: OWNER TENANT MANAGEMENT COMPANY REALTOR
Telephone Number (____) _____________________Cell Phone Number (___) ____________________
Email Address: __________________________________
Have you had a previous account with City of Elyria different than the service address?
(If different than Service Address) (City, State and Zip code)
Credit Calculation Methodology: Determine the average monthly consumption over the twelve (12) month period,
immediately preceding the leak (or period of time as an account holder, if less than 12 months). Subtract the average
monthly consumption from the consumption in dispute. Credit the customer fifty percent (50%) of the difference
between the average consumption and the consumption in dispute. (Water and sewer).
In consideration for receiving utility service from The City of Elyria at the above location, I hereby acknowledge responsibility for payment of
service billings. I will continue to make payments on my utility account until a possible leak credit is determined. All utility accounts are billed and
payment by the indicated due date is required to prevent interruption of service. You are responsible for utility service until your account is closed.
___ I understand that The City of Elyria is not responsible for water damage to this property or its contents. In consideration for having utility
service initiated/ restored at the above address, I agree to ensure that all water service facilities (sink and tub faucet/ inside and outside, toilets, etc.)
are turned off: or that the responsible account holder or designee will be present to check for leakage. We recommend that you turn off your private
shut off valve, if applicable.
Once a water leak credit amount has been determined, I understand that I will be required to have a General Release Form signed and notarized. This
Form will be mailed to me at the above address. No credit will be applied to an account without the Form being returned to EPU.
_____________________________________________________________ Date: __________________
Account Holder Signature
______________________________________________________________ Date: _________________
Property Owner/Agent Signature REV. 03/21
Print Form