OHATCHEE WATER DEPARTMENT
7801 ALABAMA HIGHWAY 77
PO BOX 645
OHATCHEE, AL 36271
PH: 256-689-0436 FAX: 256-892-1208
REQUEST FOR WATER TURN ON/OFF OR OTHER SERVICES
NAME: _____________________________________________________________________________
SSN: ______________________________________________________________________________
SERVICE LOCATION: ____________________________ OWN/RENT PROPERTY ACCOUNT # __________
(Circle)
BILLING ADDRESS: ___________________________________________ PHONE #____________
TURN ON DATE: __________________________ TIME: ________________ AM/PM
DEPOSIT PAID: $ _____________________ METER READING: _________________ DATE: _______
CUSTOMER SIGNATURE: ________________________________________________ DATE: _______
TURN OFF DATE: ________________ TIME: ___________________AM/PM
REFUNED DUE $ _________________ METER READING: ___________________ DATE: _______
CUSTOMER SIGNATURE: _________________________________________________________________
OTHER SERVICE REQUEST: _______________________________________________________________
DATE SCHEDULED: _________________________ TIME: ______________________ AM/PM
AMOUNT BILLED: $ ________________________ DATE DUE: _____________________________
CUSTOMER SIGNATURE: _________________________________________________________________
WORK PERFORMED BY: _______________________________________ DATE:______________
WE READ AND UNDERSTAND THE OHATCHEE WATER DEPARTMENT POLICY
CUSTOMER SIGNATURE: _________________________________________________________________