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Water and Waste Water Billing - Authorization Form

To be used by a spouse, family member/friend, property owner, or to identify staff of a corporation.

Not to be used for commercial purposes (eg. lawyers, mortgage companies, realtors, etc.)

Are you requesting changes as the Power of Attorney of the account holder(s)?

Allowed extensions pdf, jpg

Please allow the above referenced representative to perform the following (check all that apply):

Statement - Online Form Submission:

By submitting this online form to the Municipality, the user acknowledges that the submission is deemed to be a substitute for the user’s signature on the online form and signifies that the user has read, understood and agreed to the terms and conditions of the online form and any document referenced in the online form. If the user is submitting this form on behalf of a corporation, the user further acknowledges they have authority to bind the corporation.

Please confirm that you have read and accept the "Statement - Online Form Submission"

Privacy Statement:  Personal information on this form is collected subject to the Municipal Freedom of Information and Protection of Personal Privacy Act R.S.O. 1990, c. M. 56 and may be subject to disclosure to third parties in accordance with the provisions of that Act.  The personal information collected on this form will be used for municipal account updates.  Questions about the collection of this information may be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, Ontario N8H 2Z9, Telephone 519-326-5761.


© 2024 The Municipality of Leamington 111 Erie Street North, Leamington, Ontario N8H 2Z9

Phone: 519-326-5761
Fax: 519-326-2481
Email: General Information

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