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2. Account Number*
   999xxxxxx
4. First Name*
5. Last Name*
7. Service Address*
9. City*
10. State*
11. Zip*
13. Daytime Phone Number*
    xxx-xxx-xxxx
15. I would like the Frederick County Division of Water and Sewer Utilities to verify my water meter reading and check for a service line leak.
17. By initialing, I agree to the following terms: A technician will contact me within 2 to 3 business days after submission of this request to schedule an appointment to perform the test. I understand that I must be present at the property while the test is performed. I am aware there is a $50.00 charge for this service. This fee will appear on my next bill; however, this fee will be waived if the previous meter reading is found to have been incorrect.
18. Initials*
20. Signature*
    Enter first and last name
21. Date
    Date
23. To receive a copy of your submittal, please provide your e-mail address below. If a copy is not needed, simply un-check the "Receive email copy" box. If you have any questions, please call (301) 600-2354.
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25. 1. Receive an email copy of this form.
26. Email address

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27. Submit

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