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Application For Water Service: WWW - Cambridge.ca

The document is an application form for water service from the City of Cambridge, Ontario. It requests applicant name, service address, contact details, ID information, and signatures of all property owners or leaseholders. There is a $25 administration fee to process new accounts. All fields must be completed and questions can be directed to the provided phone number. Personal information is collected according to privacy laws and used for water and tax billing purposes.

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143 views1 page

Application For Water Service: WWW - Cambridge.ca

The document is an application form for water service from the City of Cambridge, Ontario. It requests applicant name, service address, contact details, ID information, and signatures of all property owners or leaseholders. There is a $25 administration fee to process new accounts. All fields must be completed and questions can be directed to the provided phone number. Personal information is collected according to privacy laws and used for water and tax billing purposes.

Uploaded by

jose_sebastian_2
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Office of the Chief Financial Officer

50 Dickson Street, 4th Floor


P.O. Box 669
Cambridge, Ontario N1R 5W8
Telephone: 519.740.4524
Fax: 519.740.0834

APPLICATION FOR WATER SERVICE


Please complete the application form in full. Only the owner of a property should use this form. There is an
administration charge of $25.00 for processing the new account setup. The processing fee will appear on your first
billing for this address. If you have any questions or if you require more information please call 519.740.4524 or go to
www.cambridge.ca

All fields must be completed.

Date you require service (mm/dd/yyyy): ___________________________________________________________________

Applicant’s Last Name: ________________________________Applicant’s First Name: _____________________________

Address of Service: ________________________________________________________________________________________

Postal Code: __________________________________________

ID (Drivers License Number, Passport): _____________________________________________________________________

Date of Birth (mm/dd/yyyy): _______________________________________________________________________________

Home Telephone Number: ( )__________________________________________________________________________

Employer: _____________________________________________ Business Number: ( ) - ________________________

Mailing Address if Different from Service Address: ___________________________________________________________

If there is a second owner and/or a second lease holder please complete the following:

Applicant’s Last Name: ________________________________Applicant’s First Name: _____________________________

ID (Drivers License Number, Passport): ______________________________________________________________________

Date of Birth (mm/dd/yyyy): _______________________________________________________________________________

Employer: ______________________________________________ Business Number: ( ) _________________________

This form must be signed by all owners or all lease holders to be valid.

Date: __________________________ Signature(s): ______________________________________________________________

For Office Use Only


Section Number: ________________
A Final Reading for this Service Address has been requested: Yes No
Personal Information on this form is collected as authorized by MFIPPA and will be used to manage our water and tax billings. Questions
about the collection of this data can be directed to the Information and Privacy Co-ordinator at 519.740.4680

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