Required fields are marked with asterisks (*)

High water bill adjustment application

This form is to provide financial relief to customers who have experience a high water bill situation.

If you require an alternative method to apply, please email utilities@waterloo.ca.

Your name

Your address for the high water bill account

Please provide your water account number

Please provide your telephone number

Please provide your email address

Date of invoice with high consumption

Description of leak issue

Location of leak

Date the leak was repaired

Indicate the meter reading at the time of the repair

Declaration - I acknowledge and confirm that the following statement are true and accurate:

This is a residential property. The property was not unattended for more than five days. Increased water consumption was not due to filling or leakage from a pool/hot tub, irrigation system or from lawn watering.

Please sign to acknowledge your statements and true and accurate

Clear

To the extent that the foregoing information constitutes personal information as defined in the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, chapter M.56 as amended, the information is subject to provisions of that Act and will be used for the purposes of administering the high Waterloo bill adjustment application process. Questions about the collection of personal information should be directed to the city clerk, Waterloo City Centre, 100 Regina St. S., Waterloo, ON, N2J 4A8, (519) 886-1550.

Forms

High water bill adjustment application

This form is to provide financial relief to customers who have experience a high water bill situation.