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City of Crestview
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Residential Request for Sewer Adjustment

  1. Utility Billing Department Information Header
  2. Sewer Bill Adjustment Request
    Please be advised that all requests are subject the the approval of the Public Works Director, and may take several weeks to be reviewed and applied, if approved. Only one request can be approved annually from the last.
  3. Where was the Leak Located:*
  4. Was the Leak Repaired:*
  5. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  7. This field is not part of the form submission.