Form Center

2. Leak Adjustment Form

   Please fill out the form below to request a leak adjustment from the Town. 

6. Account Information
8. Address*
10. Phone Number*
11. Email Address*
13. Account Number

    Enter the account number from your bill for the account.

15. Route Number*
16. Service Address ID*
17. Resident Number*
19. Proof of Leak
21. Dates the leak was detected and fixed:*
    Dates the leak was detected and fixed: Start Date

    —

    Dates the leak was detected and fixed: End Date
23. Please describe in detail the leak and how it has been fixed.
25. File uploads for proof of leak

    Please provide as much of the following information as possible demonstrating that you found and repaired a leak on your property.

    1. Any images showing the leak.
    2. Any images, bills, or invoices showing a leak repair was made.
    3. Any reports, bills, or invoices from an irrigation or plumbing specialist showing that a leak was found and repaired on your property.

    Please attach any invoices or bills from a 3rd party showing that the leak has been fixed. 

    Without proof of the leak and its repair, we will be unable to consider your request for a leak adjustment.

27. File Upload #1
29. File Upload #2
31. File Upload #3
33. File Upload #4
35. File Upload #5
37. Authorization of Services*

    I am the owner of this account, and I am requesting that the Town review the information provided and provide a leak adjustment to my account. I understand that the Town can only perform one leak adjustment per year and that if the leak occurred over multiple months that the Town will only be able to provide an adjustment for the month with the highest consumption. 

    1. Yes, I agree to the above statement.
39. Name of the Account Holder*
40. Date*
    Date
44. Upon completion and submittal of the application you will be returned to the Utility Billing page for the Town of Northlake's website. Please contact Utility Billing with any questions or concerns.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field