Mount Gilead, NC · Montgomery County
Utility Adjustment Application
Mount Gilead utility customers use this application to request an adjustment related to a water leak or theft at their service address.
What this form is
The application lets a utility customer request an adjustment for a leak or theft and asks for account, service, billing, and incident details. It asks whether the property is connected to a public sewer system and whether leaking water entered it, along with an explanation of the situation and repairs. The applicant certifies the information and signs and dates the form.
Who needs it
A Mount Gilead utility customer seeking an adjustment related to a water leak or theft at their service address should complete this application.
How to submit it
The form lists the Mount Gilead address as 110 West Allenton Street, Mount Gilead, NC 27306, and provides fax number (910) 439-1336.
About notarization
This application is signed and dated without a notary; for a theft request, it asks the applicant to attach a police report.
How to submit this form
- 1
Download The Application
Download the Utility Adjustment Application PDF.
- 2
Complete The Application
Enter your contact, account, service, billing, and incident information, explain the situation and repairs, then sign and date.
- 3
Gather Attachments
For a theft request, attach a police report. The form also requests supporting documentation such as photographs, receipts, or invoices as needed.
- 4
Send The Application
Use the address or fax number listed on the form: 110 West Allenton Street, Mount Gilead, NC 27306, or (910) 439-1336.
Frequently asked questions
- What is the Utility Adjustment Application for?
- It is for Mount Gilead utility customers requesting an adjustment related to a water leak or theft at their service address.
- What information does the application ask for?
- It asks for applicant, account, service, billing, and incident details, plus information about sewer connection, water entry, and repairs.
- Do I need a notary for the Utility Adjustment Application?
- No. The application is signed and dated without a notary. For a theft request, attach a police report.
- How do I submit the Utility Adjustment Application?
- The form lists 110 West Allenton Street, Mount Gilead, NC 27306, and fax number (910) 439-1336.
Need something notarized?
This Utility Adjustment Application doesn’t need a notary — but if you have another Mount Gilead form that does, a commissioned online notary can help.