2. Name:*
3. Service Address:*
4. Email Address*
6. Phone Number:*
7. Account Number:*
8. Approximate date leak appeared: *
   Approximate date leak appeared:
10. Date leak repair was completed:*
    Date leak repair was completed:
11. Documentation of repair:*
    (receipts from parts purchased to make the repair or invoice from plumber/contractor)
13. Where on your property the leak was located:*
15. Description of the leak and repair:*
17. By initialing this box, I acknowledge that I have read the City of Marysville leak adjustment policy:*
19. Leak Adjustment Policy:

    Leak adjustment requests must be submitted within 60 days of the repair.

    Once the City receives this form and the information is reviewed, we will verify the leak is fixed. After verification of the leak repair, an adjustment will be made and you will be notified. Leak adjustments are available once every 2 years, from the date of the last leak adjustment. The City of Marysville allows a customer no more than one leak adjustment per meter in any twenty four month period. Another leak adjustment will not be allowed until two (2) years following the date of repair. The adjustment can incorporate a maximum of two billing periods (4 months) for residential and commercial accounts. If the leak occurred on the City’s side of the meter or due to malfunction of the water meter, the customer will not be responsible for any excess water charges beyond the consumption for the same billing period from the previous year.

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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