Town of Mocksville

171 S. Clement Street, Mocksville NC 27028/ Office – 336-753-6700/ Fax – 336-751-9187

 

Complete the Leak Adjustment Form Below

If you prefer to complete this form and mail it with hard copies of your proof of leak, please download and print the form here.

 

 

Leak Adjustment Form

Name(Required)
Address(Required)
Drop files here or
Accepted file types: jpg, gifpng, pdf, Max. file size: 128 MB.
    Please use this area to submit copies of your receipts or pictures to show proof of leak.
    MM slash DD slash YYYY
    Consent(Required)
    Please sign online using a mouse or stylus.