Required fields are marked with asterisks (*)

Commercial Service Contract - Tenant

The information collected on this form will be used by the City of Belleville to establish and maintain a service connection and for billing and collection purposes.

We will require you to pay a deposit equal to three (3) months, which will be determined by the Water Customer Service Manager and communicated to you by email. 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.

Registered Property Owner First and Last Name:

Service Address

Street Number and Name:

Unit Number (if applicable):

Account Number:

Client Code:

Effective Date:

Customer Information

Business Name:

Common Name:

Mailing Address

Street Number and Name:

Unit number (if applicable):

City:

Province:

Postal Code:

Email Address:

Telephone:

Fax Number:

Would you like E-billing? (select one)

Yes

Signator

First and Last Name:

Position: