Please enable JavaScript in your browser to complete this form.PLEASE ENTER LANDLORD'S DETAILS BELOWLandlord's Name *FirstLastEmail *Phone * I HEREBY GIVE PERMISSION TO (NAME BELOW) TO CONNECT WATER SERVICES IN HIS/HER NAME. THEY WILL BE RESPONSIBILE FOR ANY BILLS FROM THE CONNECTION DATE.Tenant's Name *FirstLastConnection Address *Address Line 1Address Line 2CityState / Province / RegionBlock Number *Lot NumberMove in Date / Time *DateTimePrevious Tenant Name *FirstLastAS LANDLORD OF THE ABOVE PROPERTY I AGREE TO CLEARLY LABEL THE METER BOX / CHAMBER, SO THAT THE NUMBER MARKED ON THE CHAMBER CORRECTLY CORRESPONDS WITH THE APPLICATION FORM. I HEREBY ABSOLVE PROVO WATER COMPANY LTD FOR RESPONSIBILITY OF ANY WATER BILL UNDER DISPUTE AS A RESULT OF ANY INCORRECT PIPING CONNECTION (CROSS PIPES) BETWEEN THE METER AND THE RENTAL UNIT.Landlord's Signature *Clear SignatureDate / Time *DateTimeSubmit
