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2. There are a variety of circumstances which may cause a customer to have an isolated water bill in excess of their normal range of monthly consumption. Once the high bill has been received by the customer and upon receipt of this High Consumption Water Credit Application, the City may make an adjustment in accordance with City Policy. A High Consumption Application Processing Fee shall be applied to the account if an adjustment is granted. Completed applications can be emailed to wateradjustment@cocoafl.org for processing.
4. To qualify, all of the following conditions must be met:
6. • You must have received the bill with the high consumption
8. • Your high consumption water usage must be at least 50% more than your six month water consumption average.
10. • Your calculated credit must be at least $50 (unless the City of Cocoa has declared a state of emergency due to a natural disaster event)
12. • The repair must be completed and copies of receipts submitted with this application.
14. NOTE: The City of Cocoa offers water credit to all customers and sewer credits to Cocoa residents only that are connected to Cocoa's sewer system. To inquire about a sewer credit for other areas, please consult the appropriate sewer utility for a sewer credit:
16. Brevard County (321) 633-2092
17. City of Rockledge (321) 221-7540
19. City of Cape Canaveral (321) 868-1220
20. City of Cocoa Beach (321) 868-3253
22. Account Number*
24. First Name*
25. Last Name*
27. Phone Number*
28. Email Address*
30. Service Address
32. Address1*
34. Address2
36. City*
37. State*
38. Zip*
40. Bill Date of High Consumption*
    Bill Date of High Consumption Start Date

    —

    Bill Date of High Consumption End Date
41. Additional documentation.
    If you have additional documentation relating to this application, please email to wateradjustment@cocoafl.org and include your name, account number, and phone number, if this information is not included in the email, processing of your application will be delayed.
43. Date of Repair*
    Date of Repair
44. Repair receipts
    Please upload legible copies of repair receipts.
45. Repair receipts
    Please upload legible copies of repair receipts.
47. Reason for High Consumption*

    Pool/Landscape option is for a sewer credit for Cocoa Residents on Cocoa Sewer ONLY. All other customers outside the City of Cocoa's sewer system must consult the appropriate sewer utility for a sewer credit. No water credit is given on pool fills or landscape improvements.

    1. Toilet
    2. Appliance
    3. Irrigation System
    4. Outdoor Hose
    5. Pipes

    1. Faucet/Spigot
    2. Unexplained water loss
    3. Other
    4. Pool/Landscape (Sewer credit only & for customers on Cocoa sewer only)
    5. Theft (Police report must be included)
49. If you have selected theft, please upload your police report for the stolen equipment.*
51. Pool/Landscape option is for a sewer credit for Cocoa Residents on Cocoa Sewer ONLY. All other customers outside the City of Cocoa's sewer system must consult the appropriate sewer utility for a sewer credit. No water credit is given on pool fills or landscape improvements.*
53. If other, please explain:
55. Signature*
    By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
56. Date*
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field