Pool Dimensions
(ft)
OR
Secondary Phone
FULTON COUNTY FINANCE DEPARTMENT
WATER & SEWER BILLING AND COLLECTIONS DIVISION
141 Pryor St, Suite 7001, Atlanta, GA 30303
Phone: (404) 612-6830 Fax: (404) 612-0333
Email: Adjustment.Request@fultoncountyga.gov
POOL FILL CREDIT REQUEST FORM
Signature
Date
LAST Name, First Name, Middle Initial OR Business Name (if Management Company)
Email Address
Customer Name
I am requesting a pool credit due to (please specify the reason for filling: e.g. new pool built, repaired, newly painted,
other, etc.; attach documentation and/or receipts to aid processing):
Pool Capacity
(Gallons)
Lenght Width Depth
Pool Filled/Refilled
On This Date
Primary Phone
• To qualify for a pool fill credit, you must receive sewer service from Fulton County.
• If the qualifications are met, the credit is applied only to the sewer portion of the bill. For this reason, Water
Only accounts DO NOT qualify for a pool fill credit.
• Pool fill credit is a one-time credit (unless a pool re-fill was done due to a repair).
• If you have applied for and received a pool fill credit before, please make sure to include a repair receipt justifying
the new request.
• Please note that any credit issued will be reflected on your next bill.
• If there are any problems with your request, you will be notified.
City
Account Number
Street Address
Service Address
Customer Number
State
Zip Code
I understand that completion of this form does not guarantee that a pool fill credit will be issued. I also understand
that all documents, including repair receipts (if applicable), must be received before my account will be reviewed for
an adjustment. I also certify that all of the information submitted is true and correct and applies to the account for
which the credit is sought.
mm/dd/yyyy
mm/dd/yyyy
Alternatively, this application along with the
required documentation can be submitted via:
• Fax (404) 612-0333; or
• In Person at:
o 11575 Maxwell Rd, Alpharetta, GA 30009; or
o 141 Pryor St SW, 7th Floor, Atlanta, GA 30303.
• If you are using Internet Explorer, you can use the button
below to email your request directly from this page;
• If you are using Chrome, Firefox or Safari, you will need to:
o SAVE this file on your computer;
o Open it with Adobe Reader;
o Use the button below to email the request.
OR
