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Pool Adjustment Request Form

  1. *Name(s) As Listed on MWRD Customer Account

  2. Agreement*

    I certify that the POOL/POND/FOUNTAIN was filled at the address and date listed below by the company/person(s) mentioned and is now in good condition and free from leaks. In my opinion, the filling of the pool/pond/fountain was enough to increase the water bill used at the above address. I make an oath that matters set forth above are true and correct indicated by my information provided below.

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