Required fields are marked with asterisks (*)

Request for move in or move out

Please Note: 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 during regular office hours, 8:30 a.m. to 4:30 p.m. (Deaf and Hard of Hearing (TTY) : 519-575-4608), or email arwater@regionofwaterloo.ca, or fax 519-575-4448 to the attention of Accounts Receivable.

Are you moving in or moving out?

Move In

Move Out

Account Holder Information:

Account holder name(s):

Phone number:

Alternate phone number:

Email:

Alternate Email:

Are you the:

Owner

Tenant

Service Address (Address where the water account is located):

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

City/Town:

Postal Code:

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.