Pool Adjustment Request Form


Name:

Service Address:

Account Number:

Phone:

Email:

Reason for pool fill:   New Pool   Pool Refill 
Date Pool Filled: 
Approximate Number of Gallons Used to Fill Pool: 
  • Adjustment is available no more than once annually.
  • Adjustment is available only for wastewater (sewer) portion of bill.
  • In-city residential user will be billed their average monthly sewer rate as calculated for the proceeding months of January, February, and March.
  • All customers requesting a billing adjustment in accordance with these guidelines are required to pay their bill in full or make payment arrangements while this form is being processed.
  • No adjustment will be made if pool was filled during the months of June, July, or August. 
Electronic Signature - By typing your full name, you are acknowledging that the information you have provided is true and no false statements or misrepresentations have been made on this form.