Required fields are marked with asterisks (*)

New Water Account

Personal information collected on this form is collected under the authority of the Municipal Act, 2001, as amended, for the purposes of reviewing this application. Questions regarding the collection of personal information should be directed to the Municipality of West Perth, 160 Wellington Street, PO Box 609, Mitchell, ON N0K 1N0, telephone 519-348-8429 x229 Finance Department.

Please complete the form to setup your new water account.

New Account Holder Name

Are you a tenant or property owner

Tenant

Property Owner

Email Address

Phone Number

Mailing Address

Street Address

City/Town

Postal Code

Is the address for the new account different from your Mailing Address?

Yes

Are you moving from an existing residence in West Perth?

Yes

Effective Date