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Moulton Niguel Water District

conservation@mnwd.com

27500 La Paz Rd, Laguna Niguel, CA 92677

(949) 448-4025

Form Section 1
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Residential Adjustment Form

It is the sole responsibility of the customer to contact the District to request an adjustment of their water bill through the Adjustment Form. Customers must complete the Adjustment Form within one (1) month of their affected bill.

To be eligible for an adjustment of charges, the customer's water usage must be entirely within their water budget (Tiers 1 & 2) within two (2) billing periods following the repair or resolution date of the qualifying event.

Customers must keep accounts in good standing to avoid incurring any additional fees or charges. It is the responsibility of the customer to contact the Billing Department to make any payment arrangements if payment cannot be made in full at the time payment is due.

Billed units in Tiers 4 and 5 will be recalculated at the Tier 3 rate for the adjustment. Any approved adjustment will be issued as a credit on a future water bill. Checks will not be issued.

Customer Information

Full Name
Form Section 2

Adjustment of Charges

Adjustment requests must be submitted within one (1) month of the affected bill, and adjustments will be made only to the most recent bill. If approved, consumption in Tiers 4 and 5 will be recalculated at the Tier 3 rate.
Select date of leak repair
Date Picker
Attach a copy of any receipts, invoices, or documentation for the work performed
Date of pool fill
Date Picker
Attach a copy of any receipts, invoices, or documentation for the work performed.
Attach a copy of any receipts, paid invoices, or documentation for the work performed and/or new plant material. Please also include at least 1 photo of the installed plants.

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Incident (Enter N/A if not applicable)
Date Picker
As a public agency it is necessary to produce auditable documentation. Attach a copy of any receipts, paid invoices, or documentation for the work performed relating to your issue.

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As a public agency it is necessary to produce auditable documentation. Provide any details regarding your request for an adjustment due to your Irrigation Timer:

Acknowledgement of Terms and Conditions

It is the responsibility of the customer to contact the District and request a bill adjustment when they make a repair or have an issue. Any customers providing falsified information to the District may be liable for back charges. Bill calculations based on falsified information will be recalculated with corrected customer account details.

I affirm that the information contained herein, including attachments, is complete and accurate. I understand acceptable proof may be required for each bill adjustment request at the discretion of the District.

Acknowledgement Agreement
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