Required fields are marked with asterisks (*)

Application for new water and/or wastewater service

Important: you must be the owner of the property to complete this form. The water and wastewater service account will be setup in the owner’s name.

This form must be submitted at least 72 hours (3 business days) prior to the date on which you require the service.

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 email arwater@regionofwaterloo.ca or fax 519-575-4448 to the attention of Accounts Receivable.

Date the service is required:

Applicant's Information:

Legal name(s) of owners of property:

Phone number:

Alternate phone number:

Email:

Alternate Email:

Lawyer Name:

Lawyer phone number:

Lawyer Email:

New Service Address:

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

City/Town:

Postal Code:

Is your mailing address different from the service address?

Yes

Service Information:

Do you require wastewater service billing for this service address?

Yes

Have you previously had an account with us?

Yes

Declarations and Signatures:

I/We (Print name(s) of the owner(s):

Of (Print your address):

Declare as follows:

I (We) are the Owner(s) of the property at the above noted Service Address.
I (We) request that the Region of Waterloo set up an account for the purposes of billing for Water & Wastewater services.
I (We) understand that property owner(s) for a service address remain responsible for the full payment of all water and wastewater account arrears.
I (We) undertake to notify the Region of Waterloo of all tenant(s), occupant(s) and/or ownership changes (including owner address information).
I (We) agree to give the Region of Waterloo free access to the premises during regular business hours to allow the Region to read, repair, remove and replace meters.
I (We) agree to be responsible for the care of any meter or related fixture at the service property and agree to be responsible for all costs, repairs, or replacement of any meter or related fixture.
I (We) understand that if a Utility Bill is not paid on time, the Region of Waterloo, reserves the right to transfer the unpaid balance to the service address property tax bill for collection.
I (We) acknowledge that the Region has the right to cut off the supply of water whenever the bill for these utilities arrears, or I (we) are in breach of this agreement.
I (We) agree to the Region of Waterloo obtaining my personal credit information, and disclosing my personal credit information to and from other lenders, credit bureaus or other credit reporting agencies.
I (We) acknowledge and agree that this shall be the Region of Waterloo’s full and sufficient authorization to information supplied to assist in the collection of overdue accounts. The Region of Waterloo reserves the right to add a service charge of $15.00 plus the cost of running a credit report if my (our) account is in arrears.

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.