Form Center

2. City of Hampton Utility Deposit Refund Application
   Eligible utility deposit refunds will be applied directly to the customers account.
4. To be eligible you must maintain continuous service. You must have a good payment history Ci.e. no returned checks or disconnects for non-payment) within the past 12 months.
6. If you are determined eligible for a refund it will be for the full amount that was originally paid. If you are ineligible we will notify you by mail of your ineligibility and you may reapply in 1 year.
8. Date
   Date
10. Customers Name
12. Customer Address
14. City
15. State
16. Zip Code
18. Customer Account Number
19. Amount of Deposit
21. How long you have lived at this address?
23. Signature*

    1. By clicking on the submit button, this does serve as a legal signature.
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30. 1. Receive an email copy of this form.
31. Email address

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32. Submit Submit and Print

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