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Swimming Pool Repaired - Request Adjustment

  1. Repair must be submitted within 90 days after the date of the repair for eligibility.
  2. Previous repair adjustment request has occurred within the past 12 months
  3. Proof of repair examples: Licensed plumber itemized invoice, itemized receipt of repair parts.
  4. As the customer for the above noted property, I attest that all information provided is true and accurate.
  5. If meter pictures are not provided, enter number of gallons used for repair and refill of your swimming pool.
  6. Leave This Blank:

  7. This field is not part of the form submission.