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2. Requests must be received within 60 days of the date of the bill for which an adjustment is requested. Sewer credits are not guaranteed, nor granted due to the following reasons: leaks where water enters the sanitary system (leaking toilets/faucets, etc.), water used for irrigation, negligent or undetermined use of water. Sewer credits are limited to a maximum of $500.00.
4. Full Name*
6. Today's Date*
   Today's Date
7. Daytime Phone Number*
8. E-mail Address
10. Address1*
12. Address2
14. City of Cocoa Account Number*
15. Attach Cocoa Water Bills*
    Provide the consumption billing history for the three months prior to the pool fill / leak repair, along with the month the credit is asked for (4 bills in total)
17. Date of Pool Fill or Leak/Repair*
    Date of Pool Fill or Leak/Repair
    For pool fill: A copy of a receipt of the repair materials, a plumber’s bill, photos, OR a pool contractor’s invoice must be submitted. (Only one pool fill / sewer credit allowed per 12 month period.) For leak/repair: A copy of a plumber’s bill with explanation OR receipt of the repair materials, pictures, with explanation OR a contractor’s invoice must be submitted.
18. Required Attachments*
    Pool Fill Credit: Attach a copy of a receipt of the repair materials, a plumber’s bill, photos, OR a pool contractor’s invoice. Leak/Repair Credit: Attach a copy of a plumber’s bill with explanation OR receipt of the repair materials, pictures, with explanation OR a contractor’s invoice
20. Accountholder's Acknowledgement*
    I certify that I am the account holder and the foregoing information is true and accurate
22. Terms
    REQUESTS RECEIVED WITHOUT PROPER DOCUMENTATION WILL BE DENIED! CONTINUE TO PAY YOUR BILL ON TIME TO AVOID SERVICE INTERRUPTION. ANY APPROVED CREDIT WILL APPEAR ON A SUBSEQUENT BILL.
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