Domestic Account in Company Name – Provo Water Company

Are you the property owner or tenant?

Owner
Tenant

Checkboxes

Please have your landlord complete the LANDLORD CONSENT FORM

This is mandatory for all tenants (please check box to confirm you have provided details to your landlord). You must upload a completed “Landlord Consent Form” in the space provided at the end of this form.

Purpose of Application

New Supply
Reactivation of Service
Transfer to Another Location
Upgrade Connection Size

Company Details

Business License Number *

Company Registration Number *

Contact Details of Director Responsible for Billing *

First

Last

Email *

Email

Confirm Email

Cell Phone *

Other Phone

Mandatory Identification: Passport Details *

Please include issuing country and number

Secondary Identification

National Insurance Card
Driving License
NHIP
Other

National Insurance Card

Driving License

NHIP

Other

Employer Details *

Please include name, address and telephone number

Type of Premises *

Single Residence
Apartment/Condominium
Townhome

Is there an existing domestic water service on property or do you want a new connection? *

Existing Connection
New Connection

Please provide name of previous occupant

How many connection/chambers do you require? *

What size connection is required? *

5/8″ (Max Flow 15 GPM)
1″ (Max Flow 15 GPM)
2″ (Max Flow 50 GPM)
Not sure/Other

Will you require additional connections/chambers in the future? If so how many.

What is the property address where you want water service *

Address Line 1

Address Line 2

City

State / Province / Region

Block and Parcel Number of property *

When would you like your service to start? *

Date

Time

Is your billing address the same as the property address? *

Yes
No

Billing Name *

First

Last

Billing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Terms and Conditions *

I confirm that I have read, understood and agree to Provo Water Company Ltd.’s Terms and Conditions of Water Service.

Before ticking the box below, please read the Terms and Conditions of Water Service carefully. By ticking this box, you confirm that you understand your responsibilities as a customer, including payment of charges, access to the meter, responsibility for private plumbing and leaks after the meter, and the circumstances in which service may be suspended or disconnected.

Mandatory Identification *