Please complete the form below to ENROLL in Leak Protection. Account #(Required)Account Name(Required) Account Type(Required) Residential - $2.50 Commercial (Single Occupancy) - $5.15 Commercial (Multiple Occupancy) - $8.55 Please add the above charge to my monthly bill for leak protection. There is a 30 day waiting period before benefit claims can be made. Program is subject to Terms & Conditions.Signature(Required) 76768
