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2. 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.
4. Adjustment Process:
   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.
6. Service address of leak:*
   City, state, and zip not required
8. Name on the Account:*
10. 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.
12. How was the leak repaired?*
    EXAMPLES: Hired a plumber or I repaired the leak myself with changing out the flapper.
14. Upload copies of any repair receipts:
    EXAMPLES: Plumber receipt or if you repaired the leak yourself and had to buy parts, then upload the stores receipt.
16. 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:

    1. I have completed the above information.
    2. I have attached documentation/evidence of the repair of the leak that caused the large utility bill.
    3. I understand that any adjustment will be forthcoming on the next billing.
    4. I also understand I will not be eligible for another adjustment for at least (12) months.
18. Electronic signature:*
    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.
19. Date:*
    Date:
21. Email:*
22. Best Phone #:*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field