2. REVIEW BEFORE SUBMITTING FOR ADJUSTMENT:

   1. Universal City residents may request to have ONE bill adjusted within a TWO-YEAR PERIOD.
   2. Submit this form only AFTER you have received your affected high-water bill.
   3. You MUST ATTACH COPIES OF YOUR RECEIPT FROM A PLUMBER OR PARTS PURCHASED FOR REPAIR. Adjustments will NOT be considered without proper documentation.
   4. No adjustments under $5.00 will be applied.
6. ACCOUNT NUMBER:*
7. SERVICE ADDRESS:*
9. FIRST NAME:*
10. LAST NAME:*
12. PHONE:*
14. DESCRIPTION OF LEAK:*
    Please use as much detail as possible to describe the leak including date it started, location, and type of repair made.
18. SUBMIT COPIES OF REPAIR RECIEPTS FROM A PLUMBER OR FOR PARTS PURCHASED*
19. SUBMIT COPIES OF REPAIR RECIEPTS FROM A PLUMBER OR FOR PARTS PURCHASED
21. SUBMIT COPIES OF REPAIR RECIEPTS FROM A PLUMBER OR FOR PARTS PURCHASED
22. SUBMIT COPIES OF REPAIR RECIEPTS FROM A PLUMBER OR FOR PARTS PURCHASED
26. Please allow 3-5 business days for the request to be processed. You will be contacted by a water dept. staff member to accept or decline your adjustment. Any adjustment will appear as a credit to your water account. For inquiries, please call 210-659-0333 option 2.
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28. Submit

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