Form Center

2. Utility Adjustment Request Form
4. Customers of the City of Casselberry may request an adjustment on the current water bill if they have recently encountered a leak, pool fill, or unexplained/unintended usage by completing and submitting this application.

   Customers are eligible for an adjustment once per 12 month period for explained use OR once per 3 year period for unexplained use. The consumption amount should be close to double the account average. The adjustment request must be submitted within 90 days from the bill date. Submittal of this request does not prevent accounts from collection activity, including service interruption. A payment must be made on the account. Please contact Utility Customer Service at (407) 262-7700, Option 4 for further details.

7. VALID PROOF OF REPAIR MUST BE SUBMITTED BELOW
9. Please allow ten (10) business days for processing
11. Customer Name*
12. Account Number
14. Service Address*
16. Suite or Apartment Number
18. City*
19. State*
20. Zip*
22. Phone Type*
    -- Select One --CellularHomeWork

    Press the down arrow key to access the values available for this field or start typing to filter the values
23. Telephone Number*
24. Email Address
    Under Florida law, e-mail addresses are public records.
26. Please select reason for the adjustment request*

    1. Pool Fill
    2. Pool Repair
    3. New Sod
    4. Leak
    5. Unexplained or unintended usage
28. Date of pool fill or repair
    Date of pool fill or repair
29. Date of Sod Installation
    Date of Sod Installation
30. Date Leak Repaired
    Date Leak Repaired
32. Please give brief description of what occurred*
34. Please attach proof that repairs were made*
    Invoice, Receipt, Pictures, etc.
38. Acknowledgement
    By submitting this application, I am aware that only one adjustment will be granted on my account. I understand my responsibility of any balance on the account after the adjustment has been applied must be paid or my account will be subject to interruption of service and/or report to the collection agency.
40. Signature
42. Signature
43. Date
    Date
45. Submit
    Completed forms may be printed and mailed to P.O. Box 180819, Casselberry, FL 32718-0819 or delivered in person at 95 Triplet Lake Drive, Casselberry, FL 32707
47. Email Notice
    Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing
Leave This Blank:


49. Submit

* indicates a required field