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Leak Adjustment Request Form
This form has been modified since it was saved. Please review all fields before submitting.
No more than one adjustment will be made on an account within a 12-month period.
Name on Water Account
Please enter the name on the BWA water account for which you are requesting an adjustment.
BWA Account Number
Enter the BWA Account Number
Enter the service address associated with this account.
Date(s) of Leak
Enter the date or range of dates for the high water bill.
Enter the date of and a description of the repair.
Upload a copy of the paid plumber's invoice. If you made the repairs yourself, please upload a copy of the receipt for parts purchased for the repair.
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