Landlord Consent Form – Provo Water Company

PLEASE ENTER LANDLORD’S DETAILS BELOW

Landlord's Name *

First

Last

Email *

Phone *

LANDLORD IDENTIFICATION *

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Please upload a copy of your ID – this is a mandatory requirement

PROOF OF OWNERSHIP OF PROPERTY *

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Proof of ownership is a mandatory field. You may upload up to 4 proof of ownership.

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 *

First

Last

Connection Address *

Address Line 1

Address Line 2

City

State / Province / Region

Block Number *

Lot Number

Move in Date / Time *

Date

Time

Previous Tenant Name *

First

Last

AS 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 Signature

Date / Time *

Date

Time

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