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2. Complete all required fields and submit this form in order to send a request for paperless utility billing to the Hapeville Finance Department.
4. EMAIL BILLING REQUEST FORM
   **NOTE: Submitting this form will automatically set you up to receive the Hapeville Hometown News via e-mail address that you provide in the form below.
6. First Name
7. Last Name
9. Name of Company (for businesses only)
10. D/B/A
12. Mailing Address*
14. City
15. State
16. Zip
18. Property Address (list ONE primary street address, additional properties can be listed in the "Utility Bill Account #" field below)
20. Telephone #:*
21. Cell #:
22. Fax #:
24. Utility Bill Name
    Type entire name as it appears on your bill. If more than one, separate with commas.
25. Utility Bill Account #
    If more than one, separate each account # with commas.
27. E-mail Address*
29. Are you interested in receiving a paper copy of your utility bill as well as an e-mail correspondence?*

    1. Yes, send me both paper and e-mail.
    2. No, I only want paperless correspondence.
30. Do you understand by submitting this form you will now receive the Hapeville Hometown News via the e-mail address you've provided above?*

    1. Yes
    2. No
32. Additional comments:
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field