Form Center

E-mail Billing Request Form

2. Complete all required fields and submit this form in order to send a request for paperless utility billing to the Hapeville Finance Department.

   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.

   **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