2. Customer Water Leaks Form

4. This form is to be used if you are requesting an adjustment to your account regarding a leak that was repaired. This form is not a guarantee that a credit will be applied to your utility account. You will be notified by phone/email whether or not this request has been approved/denied. Also, if you have already had a previous adjustment at the current address, you may or may not be eligible for other adjustments.

6. Please note: You must continue to pay your current monthly bill, plus any special arrangements for your leak bill(s) in order to avoid disconnection of services.

8. Should you have any questions, please contact 404-669-2120 Monday - Friday 9:00am-4:00pm or email utilitiyinfo@hapeville.org.

10. Today's Date*
    Today's Date
12. Account #*
14. Full Name*
16. Address*
18. City*
19. State*
20. Zip*
22. Primary Contact Number *
24. Email*
26. Date leak was repaired*
    Date leak was repaired
27. Type of Leak*

    1. Irrigation
    2. Toilet
    3. Service Line
    4. Other
29. Brief Description of repair made: (attach additional information if necessary)*

31. Please Note: Do Not Touch Water Meter!!! Turning off the water source is not a repair. If you need a Meter Technician to assist with your plumber, please make appointments between 9:00am-4:00pm by calling 404-669-2120. If your water is running non-stop and it's after business hours, contact the Hapeville PD Non-Emergency line at 404-768-7171.

33. Do you have a receipt or invoice for the repair that was made either by a plumber or receipt where you purchased the supplies?*
    -- Select One --YesNo
37. Upload Leak Invoice*

    Please upload a copy of your repair bill or receipts. (files accepted are .pdf, .jpg, .gif, .doc)

39. By typing your name below, you agree that the information above is correct.

41. First Name*
42. Last Name*
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field