Required fields are marked with asterisks (*)

Service application for customers relocating within our service area

Please provide the first six digits of your account location

Account holder's first name

Account holders last name

Phone number

Email address

Current address

Street number

Street name

Unit number

City

Province

Postal code

What date would you like your current service to end?

New service address

Street number

Street name

Unit number

City

Province

Postal code

Date you will be assuming service?

Do you rent or own?

Rent

Own

Is your mailing address different from your service address?

Yes

Account information will only be shared with individuals who are authorized. If you would like to grant access to someone else, please use the space below to list anyone you authorize to receive information related to your account.

Would you like to add additional individuals to have access to the account information?

Yes

Notice with Respect to the Collection of Personal Information (Municipal Freedom of Information and Protection of Privacy Act)

Personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and will be used to respond to problems or concerns reported, as well as to ensure the efficiency and effectiveness of programs and services delivered by the City of Peterborough. Questions about this collection may be directed to our Customer Service Coordinator at 705-742-7777 ext. 1868 or by email.