2. 
3. Utility Account Services
   Finance Department 501 N. Anderson Street, Ellensburg, WA 98926
5. Eligibility for leak adjustment
7. Residential customer
   Residential water customers may be eligible for a reasonable adjustment of water billings for the prior six months of metered service when a previously undetected leak in the customer's service line is found and repaired. Apply for a water leak adjustment once repaired.
9. Commercial customer

   A sewer credit may be granted to a commercial customer having a leak in their water system, based upon normal billing for previous billing periods. The sewer credit shall be limited to three billing cycles. Sewer credits shall be limited to one rebate in a 12-month period with a maximum of two sewer credits in a five-year period per account. Apply for a sewer adjustment once the water leak has been repaired.

11. Date of this application*
    Date of this application
12. Date of repair completion*
    Date of repair completion
14. Applicant is a*

    1. Residential Customer
    2. Commercial Customer
15. I am the property service address*

    1. Owner
    2. Renter
17. Utility Account Number*
19. First Name*
20. Last Name*
22. Service Address*
24. Address2
26. City*
27. State*
28. Zip*
30. Email address
31. Daytime phone*
33. Repair bill*
    To process your request for a sewer or water leak adjustment we will need a copy of your repair bill. Please upload a copy of your repair bill to complete your application for adjustment.
35. Comments
37. Electronic Submittal
    Please type your name and date on the corresponding boxes below. By doing so and submitting this form electronically you certify that all the information provided on this form is true and correct to the best of your knowledge. You understand that the electronic signature is leally binding as if you were physically signing the form. Any material misrepresentations, omissions or falsehoods may result in rejection or nullification of this application.
39. Date*
40. Signature*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field