Application for Water Meter

Full Name *

Civic Address Moving To *

Phone Number *

Email *

Landlord Name (If Applicable)

Date Effective *

Would you like to receive your utility bills by email? Yes
No

Water Meter Deposit

Rates: 1) 5/8-inch meter $100 2) 3/4-inch meter $150 3) For commercial users, if average utility billing is greater than Number 1 or Number 2 above, then $300 (such as restaurant)

Connection Fee *

I hereby apply for the installation of a water meter and agree to pay the connection fee, in addition to a deposit, if applicable. If and when the service is permanently disconnected and the water account charged to me has been paid, a refund will be issued. I further agree to pay all water and sewer accounts within 30 days of receipt of same; otherwise, water service may be discontinued without notice. Attention renters: By signing this form you are giving permission to disclose amounts owing to the property owner and/or giving permission for a copy of the utility bill to be sent to the property owner. Property owners will be advised of any delinquent bills.

Signature *

Date Signed *