Required fields are marked with asterisks (*)

Water and Sewer Service - Notice of Change of Tenancy

To be completed by Owner

Owner Name

Phone Number

Owner Mailing Address

Owner Account Number

Service Address

Date of Tenancy Change

Tenant Information

I (We) request that the Township of Woolwich bill the tenants directly at the service address for all water and sewer rates and other charges attributable to the above property, including interest and fees.

Account Holder's Name(s)

Tenant Mailing Address if different from Service Address

Phone Number

Email Address

Driver's Licence Number

If payments are in default, all rates and charges shall be recoverable against the property owner as a debt owed to the Township which can include the balance being transferred to the property tax account of the Service Address.

Yes

Please provide Owner's signature

Clear

Date of Notification