Cedartown, GA · Polk County
Leak Adjustment Request
Cedartown utility account applicants use this request to seek an adjustment for billing dates affected by a leak and document the repair work.
What this form is
This request lets an applicant ask Cedartown to adjust billing for dates affected by a leak. It asks for account and contact information, the property address, requested billing dates, repair date, and a description of the issue. Applicants must provide receipts or invoices and repair details based on who completed the work; the applicant signs and dates the request.
Who needs it
A Cedartown account applicant seeking a billing adjustment for a leak should complete this request and provide the requested repair documentation.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details. The form lists City of Cedartown, 201 East Avenue, Cedartown, GA 30125.
About notarization
This document is signed without a notary; the applicant signs and dates the request and attaches the specified repair invoices, receipts, or work details.
How to submit this form
- 1
Download The Request
Download the Leak Adjustment Request PDF.
- 2
Complete Applicant Information
Fill in your account and contact details, property address, requested billing dates, repair date, and issue description.
- 3
Gather Repair Documentation
Attach an invoice or receipt for licensed-professional work, or receipts and a description of work and materials for other repairs.
- 4
Sign And Date
Sign and date the request.
- 5
Submit To Cedartown
Use the city contact information shown on the form and check the city website for current details.
Frequently asked questions
- What information does the Leak Adjustment Request ask for?
- It asks for applicant and account details, the property address, billing dates for adjustment, repair date, issue description, and information or documentation about the repair.
- What repair documents should I include?
- For work by a licensed professional, provide company information and attach an invoice or receipt. Otherwise, attach receipts for repairs and describe the work and materials used.
- Do I need a notary for the Leak Adjustment Request?
- No. The applicant signs and dates the request without a notary; attach the repair invoices, receipts, or work details specified on the form.
- How do I submit the Leak Adjustment Request?
- The form lists City of Cedartown at 201 East Avenue, Cedartown, GA 30125. Check the city website for current contact details.
Need something notarized?
This Leak Adjustment Request doesn’t need a notary — but if you have another Cedartown form that does, a commissioned online notary can help.