Residential 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.

FIRST APPLICANT DETAILS *

First

Last

Email *

Email

Confirm Email

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

Is there a second applicant?

Yes
No

SECOND APPLICANT DETAILS

First

Last

Email (Second Applicant)

Phone (Second Applicant)

Passport Details (Second Applicant)

Please include issuing country and number

Secondary Identification (Second Applicant)

National Insurance Card
Driving License
NHIP
Other

National Insurance Card (Second Applicant)

Driving License (Second Applicant)

NHIP (Second Applicant)

Other

Employer Details (Second Applicant)

Please include name, address and telephone number

Type of Premises *

Single Residence
Apartment/Condominium

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″
1″
2″
Not sure/Other

What "Gallons per Hour" do you require?

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/We the undersigned, hereby declare that to the best of my knowledge all the above is true and correct. I/We understand that any incorrect information may result in disconnection of supply and additional charges.
I/We the undersigned understand that penalties will be automatically applied to my/our account and a report filed with the RTCIPF if the seal is broken on the meter assigned to me/us. The fee for seal tampering is $500.
I/We the customer and undersigned acknowledge that having agreed a service turn on date, I/we is/are responsible to ensure no unnecessary losses occur as a result of turn-on. Should any losses occur in this matter we absolve PWCo of responsibility
I/We the undersigned understand and agree to pay all charges that these services are subject to the under the rates and regulations of Provo Water Company Ltd., which is provided to me/us at sign-up and the company’s web site.
I/We the undersigned, acknowledge that connection or reconnection will not be made until all fees are paid.
I/We the undersigned, agree to provide the employees and technicians of Provo Water Company Ltd. Access to water meters and equipment on my/our premises.
I/We the undersigned, hereby acknowledge that accounts due 14 days after presentation accrue interest at 2% per month. Additionally, if the account is not paid in full after 14 days , the supply will be disconnected. When supply has been disconnected, the fee for reconnection will be $25.00. Monies received before 1 pm, services reconnected the same day. Reconnection of service occurs after 3 pm daily.
I/We the undersigned, hereby acknowledge that a $95.00 fee will be charged on all ‘NSF’ cheques from the bank. Cheques marked ‘Closed Account’ will result in service disconnection without notice. If account is disconnected for non-payment of a ‘NSF Cheque”, I/we must pay the amount of the cheque plus the $95.00 fee and reconnection fee of $25.00 in cash before the service can be restored. There will be no call-outs after hours to open meters disconnected for nonpayment of ‘NSF Cheques’. To have service restored on the same day, payment must be received by 1 pm.
I/We the undersigned, hereby acknowledge that instructions to close account should be submitted in writing to Provo Water Company Ltd. 48 hrs prior to the required date of disconnection. All balances due at time of closure will be deducted from the security deposit held. Security deposit refunds are released 14 days after date of closure.

Mandatory Identification *