Per Town Code 74-421 (c): Water Customers shall be responsible for and billed for all water delivered through the meter.... 

In the case of a leak that has occurred inside the structure (internal leak) or a confirmed ground leak (outside), a courtesy leak adjustment may be applied for.

For an adjustment to be eligible for consideration, the customer must:

1. Promptly and properly repair the leak within 10 days of discovery.
2. Provide written proof of repairs to the Town of Herndon in the form of receipts or an invoice.
3. Not have received such credit during the five years preceding the date of discovery of the water service leak.

No credit shall be allowed for the period beginning ten (10) days after the date such leak was discovered .

Please see Town Code Section 74-424 for more information.

Personal Information

 *

Personal Information

Name	Address
Phone	Email
Account #

Type of Leak:

Type of Leak:

Toilet

Ground

Other Inside

Other (explain below)

If other, please explain:

If other, please explain:

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.)

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.)

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Attach proof of repairs in the form of receipts or an invoice. (Please upload your documents below.) Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

 

By signing this document, I am requesting to be considered for a leak adjustment on my/my tenant's water bill.  I understand this option is only available once every five years. Furthermore, I understand that if a leak adjustment application is not approved, I am responsible for full payment of all billed usage.

Typing your name in the space below serves as your electronic signature.

 *

By signing this document, I am requesting to be considered for a leak adjustment on my/my tenant's water bill. I understand this option is only available once every five years. Furthermore, I understand that if a leak adjustment application is not approved, I am responsible for full payment of all billed usage. Typing your name in the space below serves as your electronic signature.

Name

Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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