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2. 
4. 18631 SE 300th Place Covington, WA 98042 Phone: 253-631-0565 Fax: 253-867-0878
7. LEAK ADJUSTMENT REQUEST FORM
9. Since our community’s groundwater supply is limited and using it efficiently is of prime importance, the District urges customers to repair all leaks promptly. To support our customers in this endeavor, the District offers one leak adjustment, every eight years during the term of home ownership. Customers pay their average consumption plus 50% of the remaining leak consumption. Average consumption is based on the actual consumption for the same period in the previous two years. Leak adjustments may only cover two consecutive billing periods. Please provide the information requested below and return this form to the District. You will be notified regarding the outcome of your request. If you have any questions, please contact Customer Service at (253) 631-0565 during regular business hours.
11. Customer Name*
12. Email Address
14. Service Address*
15. City*
16. State*
17. Zip Code*
19. Phone #*
21. Approximate Date Leak Noticed*
    Approximate Date Leak Noticed
22. Date Leak Fixed
    Date Leak Fixed
24. Exact Location of Leak*
26. Description of Repairs*
28. Leak Repaired By*
30. Process AUTO PAY?*

    1. Yes
    2. No

    CWD will make every attempt to stop auto pay for large balances; however, it is the customer’s responsibility to notify CWD immediately after billing that AUTO PAY should be suspended.
32. Please attach any relevant receipts or invoices:
34. A copy of the repair invoices or store receipts for parts used in the repair must be attached in order for the request to be processed.
36. I hereby notify the Covington Water District that I have sustained a water leak at the above address and that it has been repaired. I am requesting an adjustment to my utility bill per District policy. I acknowledge that signing this form does not guarantee a billing adjustment will be granted and that if I am authorized to receive an adjustment only one leak adjustment will be allowed for my account in any 8 year period.

38. I have checked my low flow indicator for movement and confirm no movement was detected.

40. Property Owner Signature*

    1. By checking the box you agree that the information on this form is correct.
41. Date*
    Date
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field