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2. 
4. Leak Adjustment and High-Water Use Policy
   Leak Adjustment and High-Water Use Policy

   Resolution 2018-010-R
6. Account Information
8. Customers Account Number:
10. Customers Name:*
    Provide the name as listed on the account.
12. Service Address*
    Where the repair took place.
14. Home Phone
15. Work Phone
17. Cell Phone*
18. Email Address
20. Range of high bill dates caused by leak:*
22. The date and description of the repair:*
24. This form must be submitted within 60 days of the leak repair in question along with a copy of the repair receipt or paid in full invoice.
    A copy of the repair receipt or paid in full invoice can be uploaded within the section provided within the application, e-mailed to utilities@robinsontexas.org or mailed to 111W. Lyndale, Robinson, TX 76706 Att: Utilities Department
26. Upload a Copy of the Repair or Paid in Full Invoice Here
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field