Required fields are marked with asterisks (*)

Residential - Tenant

Service Information - The information collected will be used by the City of Belleville to establish and maintain a service connection and for billing and collection purposes.

Street Number

Street Name

Unit Number

Date of occupancy

Last Name

First Name

Proof of Identification (Passport, Driver’s License, Permanent Resident Card, Photo ID):

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Would you like to add another name to the account?

Yes

Email Address

Would you like E-billing? (select one)

Yes

Would you like to sign up for a Pre-Authorized Payment plan?

Yes

Telephone Number

Add another phone number

Yes

Telephone Number

Previous Address

Place of Employment

Date of Birth

Registered Property Owner

A deposit is required for tenants as per By-Law 2020-237 Schedule "A"

A $270.00 Security Deposit will be applied to your first bill.

The deposit can be waived, if you indicate you have had a previous Water account with the City of Belleville for more than two years with a good payment record. You will need to let us know this this information for us to check our records when you send in your completed application. Billing Supervisor will determine if the deposit can be waived, and this will be communicated to you.

Terms and Conditions

I/We the customer hearby make application to the City of Belleville for Water and wastewater services. Service is to be supplied at the address and on the premises described above and will commence on the date indicated on this application.

I/We the customer agree to pay for such service as bills are rendered and to utilize the service in accordance with the Rates, Rules and Regulations in effect by the City of Belleville or any other regulatory authority having jurisdiction.

The City of Belleville makes every effort to ensure bills are accurate. The City of Belleville reserves the right to collect under billed amounts at any time in accordance with the relevant bylaw.

The City of Belleville agrees to use reasonable diligence in providing a regular and uninterrupted supply of water; however will not be liable for damages by reason of any failure on the delivery of such service.

The City of Belleville assumes no risk and shall not be liable for damages from the presence of its equipment on the customer's premises.

I hereby confirm that the information contained herein is true and accurate and agree to the terms and conditions described.

Agree

Signature

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City offers Equalized Payment Plans but requires at least one year of billing to be eligible. For more information please contact us at 613-966-3657