Form

Application for Water/Sewer Service
Service Address:*
Begin Date of Service
Month Day Year
Name:*
Billing Address:*
State:
Zip code:
Phone:*
SSN or Fed Tax ID#*
Consumer Status:

Owner lives at service address Owner Does Not live at service address Tenant or Business Multi-Unit in Tenant\'s Name Multi-Unit in Owners Name
Employer:
Employer Phone:
In Case of Emergency Please Contact:
Emergency Phone Contact#:
• The undersigned hereby agrees to pay for water and sewer service provided in accordance with the rates set by City Ordinance, additional fees for collection of account will be incurred and paid by consumer
• Water System By Laws & Regulations Rule 12 requires: All rental units to pay a $150.00 permit fee, refundable at service disconnection providing there is not a balance. The final billing amount will be taken from this permit fee.
• All Ontario residents are required to file City of Ontario Income Tax
Submission Date
- Month - Day Year
at
/ Hour Minutes
Complete box for verification:*
Should be Empty:

Application for Water/Sewer Service