Leak Credit Form

Leak Credit Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

GPSD Account Number *

Are you the owner or occupant? *

Owner Occupant

Occupants at time of leak *

Describe what happened at the property *

When was the leak repaired? *

Did water enter the sanitary sewer system? *

Yes No

Did you contact the water company for an adjustment? *

Yes No

If yes, when? *

If you are eligible, credit will be given for water use in excess of your calculated average sewered water use, less any year around discount for unsewered water which you may or may not receive.

By clicking submit, you verify that the above information is true and accurate to the best of my knowledge. GPSD reserves the right to reject any application or credit.

Submit