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Leak Adjustment Request Form
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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
Service Address
*
Enter the service address associated with this account.
Phone Number
*
Email Address
*
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 Receipt(s)
*
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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Email address
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