Application For Additional Services

Name *

First

Last

Account Number *

Phone *

Email *

OWNER IDENTIFICATION *

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

This is a mandatory field. Please upload your passport and one other form of identification.

Address of Connections *

Address Line 1

Address Line 2

City

State / Province / Region

Apartment / Condo Numbers if necessary

Block & Parcel Number

Type of Premises *

Number of Connections required *

PROOF OF OWNERSHIP OF PROPERTY *

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

This is a mandatory field. Please upload up to 4 forms of proof of ownership.

PHOTO OF METER CHAMBER LOCATION *

Drag & Drop Files, Choose Files to Upload You can upload up to 4 files.

This is a mandatory field. Please ensure the location on the photo is marked with spray paint.

Signature *

Clear Signature

I/We the undersigned hereby declare that to the best of our knowledge all the above information is true and correct. I/We understand that any incorrect information may result in disconnection of supply and additional charges. Connection charges are none-refundable. I/We agree to pay all charges related to the connection and supply of water as set out by the company’s charging scheme and abide by regulations of PROVOWATER COMPANY LIMITED. I/We acknowledge that connection or reconnection will not be made until all fees and deposits have been paid.

Date Signed

Date

Time

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Monday	9:00 AM — 4:00 PM
Tuesday	9:00 AM — 4:00 PM
Wednesday	9:00 AM — 4:00 PM
Thursday	9:00 AM — 4:00 PM
Friday	9:00 AM — 4:00 PM
Saturday	Closed
Sunday	Closed