Water & Sewer Move In Form

2. Section 1 – Service Address Information

4. Purchased Home

   1. Yes
   2. No

   If No, please be aware that all utility accounts must be in property title owner’s name. If property is a rental please have property owner fill out rental application.

5. Move in Date
   Move in Date

7. Service Address

8. City

9. Postal Code

11. Utility Account Number

    Internal Use

13. A $50 Connection/Administration Fee will be charged on your first bill.

17. Section 2 – Homeowner Information

19. Last Name, First Name

    Last Name, First Name

20. Home Phone

21. Work / Cell Phone

25. Last Name, First Name

    Last Name, First Name

26. Home Phone

27. Work / Cell Phone

31. Section 3 - Welcome Wagon

33. Do you consent to your name, address and home/cell phone number being released to the Welcome Wagon representative so that they can pay you a visit as a new resident?

    1. Yes
    2. No

34. Other Applications You May Need
    - Business License Application<br> - Pet License Application<br> - Tax Installment Program Plan<br> - Utility Account Pre-Authorization

    - Business License Application
    - Pet License Application
    - Tax Installment Program Plan
    - Utility Account Pre-Authorization

38. Section 4 - Authorization

40. We/I, the registered Owner(s) of the above service address understand we/I are responsible for the Utility Bills. Non-payment of the Utility Bills will result in either disconnection and/or transfer of outstanding balances to your tax account pursuant to Beaumont’s Bylaws.
    
    We/ I certify that the information given on this form is true and complete to the best of my knowledge and acknowledge my authorization of the information to be used for the purposes identified above.

42. Registered Owner Signature

43. Date
    Date

45. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature

48. If you have questions about utility contact:
    City of Beaumont - Utilities<br> 5600 - 49 Street<br> Beaumont, AB T4X 1A1<br> Phone: 780-928-1351<br> Fax: 780-929-8729<br> <a class="Hyperlink" target="_self" href="mailto:utilities@beaumont.ab.ca">Email</a>

    City of Beaumont - Utilities
    5600 - 49 Street
    Beaumont, AB T4X 1A1
    Phone: 780-928-1351
    Fax: 780-929-8729
    Email

49. The personal information requested on this form is being collected under the authority of the City of Beaumont Bylaw 382 and Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used as for the purpose of setting up utility billing.
    
    If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at:
    City of Beaumont's FOIP Coordinator
    5600-49th Street
    Beaumont, AB T4X 1A1
    Phone: 780-929-8782

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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

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