Wellston, OH · Jackson County
Leak Insurance Application
Wellston Water Service customers use this application to voluntarily enroll in leak insurance, which adds a monthly fee to their water bill.
What this form is
This application lets Wellston Water Service customers voluntarily enroll in leak insurance. The document says coverage begins 30 days after submission and adds a $3 monthly fee to the bill; it covers up to $1,000 per meter per calendar year. Applicants provide their name, address, account number, application date, and customer signature, with a separate signature line for the clerk.
Who needs it
Wellston Water Service customers who choose to enroll in leak insurance should complete the application with their account and contact information.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details for enrollment.
About notarization
This application is signed and dated without a notary; the customer and clerk provide signatures, and no notarized attachment or sworn step is listed.
How to submit this form
- 1
Download The Application
Download the Wellston Leak Insurance Application PDF.
- 2
Complete The Application
Enter your name, address, account number, and application date, then sign the customer line.
- 3
Gather Attachments
No attachments are listed for enrollment. The document says a receipt showing a leak was fixed is required in the event of a leak.
- 4
Submit To The City
Submit the application to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does Wellston leak insurance cover?
- The document says coverage is limited to $1,000 per meter per calendar year. In the event of a leak, the bill is adjusted to the average monthly amount for the previous 12 months.
- How much does leak insurance cost?
- The application states that a $3 monthly fee will be added to the customer's bill. Enrollment is voluntary, and coverage begins 30 days after the application is submitted.
- Do I need a notary for the Leak Insurance Application?
- No. The customer and clerk sign the application; no notarized attachment or sworn step is listed.
- How do I submit the Leak Insurance Application?
- Submit it to the city department named on the form; check the city website for current contact details for enrollment.
Need something notarized?
This Leak Insurance Application doesn’t need a notary — but if you have another Wellston form that does, a commissioned online notary can help.