Non-Domestic Service Application – 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.

Company Name *

Type of Business *

Corporation
Partnership
Sole Propriertership

Type of Property/Business

Business Email *

Email

Confirm Email

Business Phone Number *

Business License Number

Company Registered Number

Owner Name *

First

Last

Owner Email *

Email

Confirm Email

Owners Phone *

Owner Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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

Is there a second authorized signatory?

Yes
No

SECOND SIGNATORY NAME

First

Last

Email (Second Signatory)

Email

Confirm Email

Phone (Second Signatory)

Passport Details (Second Signatory)

Please include issuing country and number

Secondary Identification (Second Signatory)

National Insurance Card
Driving License
NHIP
Other

National Insurance Card (Second Applicant)

Driving License (Second Applicant)

NHIP (Second Applicant)

Other

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 connections/chambers do you require? *

What size connection is required? (Also shows flow capacity). *

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

When would you like your service to start? *

Date

Time

Service Address *

Address Line 1

Address Line 2

City

State / Province / Region

Block and Parcel Number of service address *

What is your billing name and address? *

Owners Address
Service Address
Other

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 *