Follow the steps to successfully complete your leak adjustment request

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the 'Customer Name' field. Ensure that you print your name clearly.
3. In the 'Service Address' section, input the complete address where the leak occurred, including any apartment or unit numbers if applicable.
4. Fill out the 'City' field with the respective city name associated with your service address.
5. Enter the 'State/Zip' code, ensuring the zip code corresponds accurately to your service address.
6. Provide your account number in the appropriate section, as found on your billing statement. This is vital for identifying your account.
7. Indicate the 'Date Leak Fixed' field with the exact date when the leak was repaired. This information is important for processing your request.
8. Input your contact number in the 'Phone No.' section, where Aqua can reach you for any follow-up questions.
9. List the 'Billing Month(s) Affected' by the leak in the designated space to help Aqua assess the impact on your bill.
10. Sign and date the form in the provided 'Customer Signature' and 'Date' fields to validate your request.
11. After completing the form, ensure to attach copies of the repair bills and receipts as proof of the repair work done.
12. Save the completed form, and if necessary, download or print it to submit via email or fax to Aqua America.

Submit your completed and signed document online for prompt processing of your water leak adjustment request.