Required fields are marked with asterisks (*)

Lakefield Water and Sewer: Account Changes

(tenants or owners of unrented properties)

Please use this form to:

Tenants: create your account with Selwyn. Note: your account must be authorized by the property owner prior to your account being created. We will contact the property owner based on the information you provide below.
Advise us you are a new tenant who will be paying the water & sewer bills
Advise us of a move in date
Advise us of a move out date
Change the account holder name

Note: If a tenant has advised us of a move out, with no new tenant to move in, the property owner will receive the Water and Sewer Invoice.

Effective date:

Change:

New Tenant Account / Move in

Tenant Move Out

Account holder name change

New owner (early account setup: transaction pending)

Property address (including unit identifier, if applicable):

Occupant type:

Owner

Tenant

Applicant name:

Phone number:

Mailing address (must include PO Box, where applicable)

Email:

Would you like to enroll your account in paperless billing?

Yes, paperless billing through Virtual Town Hall

No, paper bill

Would you like to enroll in a Pre-Authorized Payment Plan?

Yes

Signature:

Clear

Personal information on this form is collected under the authority of the Municipal Act 2001, and will be used to process billings, building/planning applications, GIS updates and assessment processes. The personal information submitted will be used to provide you with information or updates on services or activities that the Township of Selwyn delivers under the Municipal Act or other legislation. Questions about the collection of this personal information should be directed to the Clerk.