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Pool Filling Adjustment Form

2. POOL FILLING ADJUSTMENT FORM

4. First Name*

5. Last Name*

7. Service Address*

9. Account Number*

10. Contact Number*

12. Date Pool Was Filled*
    Date Pool Was Filled

14. Beginning Meter Number At Time of Fill*

15. End Meter Number At Time of Fill*

17. Customer's e-Signature*

    I have read the Pool Fill Adjustment Policy bullet points below.

19. City of Lowell Pool Fill Adjustment Policy
    Only one pool filling adjustment is given per year for each address. The adjustment will be for the sewer portion that is above the normal usage. However, if you are a water only customer or fill your pool from an irrigation meter, you will not be eligible for an adjustment. The average will be calculated using the average water usage for the last six months. It may take up to two billing cycles for your adjustment to reflect on your account. Any current balances on accounts must be paid in order to avoid disconnection due to non-payment. A credit will be applied back to your account once the adjustment is approved.

    Only one pool filling adjustment is given per year for each address. The adjustment will be for the sewer portion that is above the normal usage. However, if you are a water only customer or fill your pool from an irrigation meter, you will not be eligible for an adjustment. The average will be calculated using the average water usage for the last six months. It may take up to two billing cycles for your adjustment to reflect on your account. Any current balances on accounts must be paid in order to avoid disconnection due to non-payment. A credit will be applied back to your account once the adjustment is approved.

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

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