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2. The City of Robinson allows a single-family residential customer to apply for a credit adjustment for an “undefined high water use bill” provided that: the customer has at least 13 consecutive months of water use at the service address; the undefined high water use bill was greater than two times the average water use and the customer has not received an adjustment in the previous 24 months.
4. Account Information
6. Customers Name:*
   Name listed on the account.
8. Service Address*
10. Account Number:
12. Home Phone
13. Work Phone
15. Cell Phone*
16. Email Address
18. Service period of undefined high water use bill (as printed on the bill):*
20. Does this address have landscaping that is watered?*

    1. Yes
    2. No
21. How is landscaping watered?*

    1. Irrigation System
    2. Hose
    3. Both
23. If an irrigation system is used, can you confirm the system does not have any broken or leaking sprinkler heads, there are no excessive run times, and there is no water run-off?*

    1. Yes
    2. No
24. Check the days the irrigation system is set to run:*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
26. Check the days landscaping is watered with a hose:*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
27. Does this service address have a pool or spa?*

    1. Yes
    2. No
29. Were you away from the property during the period covered by the high bill:*

    1. Yes
    2. No
30. If yes, how many days?*
32. Have you established a new landscape (new sod, new trees, xeriscaping)?*

    1. Yes
    2. No
33. Were there any plumbing repairs?*

    1. Yes
    2. No
34. Did you refill your pool or spa?*

    1. Yes
    2. No
36. Did you have anyone stay with you for an extended amount of time?*

    1. Yes
    2. No
37. If yes, list the number of guest.*
38. How long did they stay?*
40. Customers Acknowledgement
42. BY PROVIDING YOUR NAME BELOW, YOU ARE CERTIFYING THAT THE INFORMATION THAT YOU HAVE PROVIDED HEREIN IS TRUE AND CORRECT.*
    AGREED AND UNDERSTOOD:
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field