Required fields are marked with asterisks (*)

Request to change mailing address

If you have any questions or wish to make your application by phone, please call Accounts Receivable at 226-753-2261 or 519-575-4490 (Deaf and Hard of Hearing (TTY): 519-575-4608) during regular office hours, 8:30 a.m. to 4:30 p.m., or fax 519-575-4448 to the attention of Accounts Receivable.

Date the service is required:

Water and wastewater account number:

Legal name(s) of owners of property:

Are you the:

Owner

Tenant

Service Address:

Address (Street, Apt. No., P.O. Box, R.R. No.):

City/Town:

Postal Code:

Old Mailing Address:

Address (Street, Apt. No., P.O. Box, R.R. No.):

City/Town:

Postal Code:

Phone number:

Alternate phone number:

Email:

Alternate Email:

New Mailing Address:

Address (Street, Apt. No., P.O. Box, R.R. No.):

City/Town:

Postal Code:

Phone number:

Alternate phone number:

Email:

Alternate Email:

Account Holder Signatures:

Owner signature (1):

Clear

Date:

Owner signature (2):

Clear

Date:

Personal information collected is pursuant to the Municipal Freedom of Information and Protection of Privacy Act, as amended, under the authority of Part XII of the Municipal Act, as amended, and will be used for the purposes of administration of the municipal water and wastewater services. Questions about this collection should be directed to the attention of Accounts Receivable, Regional Municipality of Waterloo, 150 Frederick Street, Kitchener ON N2G 4J3.