Pool Fill Adjustment Request

Please fill in the form below. Along with this form, you are required to attach your receipts and/or a letter from the company or person(s) who installed the pool or made the repairs. If you completed the installation or made the repairs yourself and no receipt is available, then you are required to provide a statement specifying what, when and where repairs were made. It is important that you send or fax this form along with your repair receipt(s).

You may also download and complete our pool fill adjustment packet instead.

Customer Name:

Service Address:

Account Number (If Known):

Date the pool was filled:

Cell Phone/Main Contact Number:

Email Address:

Dimensions of the pool -
Capacity (in gallons):

Length (in feet):

Width (in feet):

Shallow End Depth (in feet):

Deep End Depth (in feet):

Attach supporting documents for the install or repair listed above, such as plumber's bill or receipt for parts (pdf, jpg or png - 10 mb max)

I am requesting a pool credit for an initial, one time, pool fill upon of a new pool. I have attached all supporting documentation. I understand that upon review by the JWSC, I may be considered for a credit adjustment only on the sewer portion of my bill. I understand that I must allow 30 to 90 days for my adjustment to be processed, during which time I will continue to pay my usual charges each month.