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2. Name on Account:*
3. Account Number:*
5. Contact Name (if different):
7. Street Address:
8. Phone Number:*
10. Email Address:
12. Reason for Request (check all that apply):

    1. I received an abnormally high water bill
    2. I’m interested in Water Efficiency and Conservation
    3. I suspect I have leaks
    4. Other
14. Explain "other" above:
18. What type of property is this?*
    -- Select One --Single Family ResidentialApartmentCondominiumNon-residentialOther
19. How many residents age 12 or older?
20. How many residents under the age of 12?
22. How many units are in the building?
24. What type of business or organization is located at this location?
25. How many employees work at this location?
27. If "other," please describe:
31. Does the property have any of the following?

    1. Irrigation System
    2. Pool
    3. Water Feature (fountains, ponds, etc.)
    4. Water Softening System
32. How many bathrooms are in your home/business?
36. Toilets are the most common source of leaks in the home. We recommend you check your toilets for leaks at least once a year.
38. Have you checked your toilets for leaks using dye tablets or food coloring?

    1. Yes
    2. No
39. This is very easy to do.
    To learn how, click here for a simple video tutorial.
41. What were the results?

    1. Color appeared in bowl
    2. No color appeared in the bowl
    3. I don't know
45. Have you contacted a plumber regarding any issues recently?

    1. Yes
    2. No
47. What were the findings?
51. Please Note:
    We will review your account information and contact you to scheduled an appointment. There is no fee associated with a phone consultation or virtual visit. If a complete in-person Water Use Assessment is completed, a $25 service fee will be added to your account upon completion of the Water Use Assessment. Water Efficiency staff may help identify leaks, but cannot make any repairs.
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53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field