Wellston, OH · Jackson County
Water Leak Insurance Enrollment
Wellston Water Service customers use this form to voluntarily enroll an account in the city’s water leak insurance program.
What this form is
This form enrolls a Wellston Water Service customer in the voluntary Water Leak Insurance Program. It asks for the customer’s name, service address, account number, application date, and signatures. The program costs $3.00 per month, has a 20-day waiting period, and provides eligible bill coverage for leaks; customers must notify the water department and provide proof of completed repairs.
Who needs it
Wellston Water Service customers who want voluntary leak coverage for their account complete and sign this enrollment form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the customer and clerk sign it, and no notarized attachment or sworn step is listed.
How to submit this form
- 1
Download The Form
Download the Water Leak Insurance Enrollment form.
- 2
Complete The Application
Enter the customer name, address, account number, and application date, then sign the form.
- 3
Keep Repair Proof
If a leak occurs, the document requires notice to the water department and proof of completed repairs, such as a valid receipt.
- 4
Submit To The City
Submit the form to the city department named on it; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Water Leak Insurance Enrollment?
- No. The customer and clerk sign the form; it lists no notarized attachment or sworn step.
- How do I submit the Water Leak Insurance Enrollment?
- Submit it to the city department named on the form; check the city website for current contact details.
- Who can enroll in Wellston’s leak insurance program?
- The document says the voluntary program is offered to any customer of the Wellston Water Service.
- What does the leak insurance program cost?
- The form states that a $3.00 monthly fee is added to the customer’s bill if they enroll.
Need something notarized?
This Water Leak Insurance Enrollment doesn’t need a notary — but if you have another Wellston form that does, a commissioned online notary can help.