Skip to Main Content
Do Not Show Again
How Do I...
Select a Category
Centennial Celebration Forms
City Secretary's Office
Contact Forms - Administration
Contact Forms - Council
Contact Forms - Court
Contact Forms - Fire Dept
Contact Forms - Parks and Rec
Contact Forms - Police Dept
Contact Forms - Public Works
Contact Forms - Utilities Billing
Parks & Recreation
West University Place Citizens Academy
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Leak Adjustment Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Per West U's Code of Ordinances Sec. 86-37. (a)
Defects in the user's water system. A user may request a correction of a utility bill because of a loss of water through a defect in the user's water system. The adjustment may be made for a period not to exceed six consecutive monthly billing periods preceding the filing of a written application on a form furnished by the city. No adjustment will be authorized until the leak in the system is repaired. The adjustment will be calculated using average water usage plus one-half of the actual usage for the billing period(s) to be adjusted.
The adjustment will be calculated using average water usage, which will be the last (12) months prior to the leak, but not less than (3) months, plus one‐half of the actual usage in excess of the average for the billing periods(s) to be adjusted. The city will absorb 50% of the difference between the high bill and your average bill. We will only look at the last (6) consecutive months that have already been billed from the time you submit the adjustment request.
To request this adjustment, complete and submit this form. If you have a repair receipt, please attach a copy of and make a brief description on how it was repaired.
Service address of leak:
City, state, and zip not required
Name on the Account:
Period in question:
This will be the months you are requesting the adjustment for. Remember we will only look at the last (6) consecutive months that have already been billed from the time you submit the adjustment request.
How was the leak repaired?
Hired a plumber or I repaired the leak myself with changing out the flapper.
Upload copies of any repair receipts:
Plumber receipt or if you repaired the leak yourself and had to buy parts, then upload the stores receipt.
Reason for requested adjustment:
I am requesting a reduction in the utility bill(s) from the City of West University because of a defect experienced at the property above.
Please check all of the below:
I have completed the above information.
I have attached documentation/evidence of the repair of the leak that caused the large utility bill.
I understand that any adjustment will be forthcoming on the next billing.
I also understand I will not be eligible for another adjustment for at least (12) months.
By typing your name into this field, you understand that the information given above will be used in processing your adjustment request. You are also agreeing that the information given to the City is correct.
Best Phone #:
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
▲ Back to top
Agendas & Minutes
Trash & Recycling
Parks & Senior Services
Government Websites by
Slideshow Left Arrow
Slideshow Right Arrow