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Application information

Possession Date*
Possession Date
Service Address*
Applicant Name*
Legal Name Only
Co-Applicant Name
Legal Name Only
Phone Number*
Co-Applicant Phone Number
Email Address*
Co-Applicant Email Address
Paperless Billing*
1. Yes
2. No
Email Address
Pre-Authorized Payment
1. Yes
2. No
You will need to complete a Pre-Authorized Payment form together with a void cheque at the town office.
Pre-Authorized Payment Form
Pre Authorized Payment Plan Utility Instalment Agreement
Click this link for pre-authorized payment plan form.
Mailing Address with Postal Code
(If different than Service Address above)
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Tenant and Property Manager Information

Optional - Information About Any Tenants of This Property (Residential or Commercial)
If you wish a copy of the monthly billing sent to either the Tenant or the Property Manager, complete the following.
Tenant Name
Date of Occupancy
Date of Occupancy
Tenant Mailing Address with Postal Code
Tenant Phone Number
Tenant Email Address
Paperless Billing
1. Yes
2. No
Attach Lease Agreement
If your lease clearly states the responsible party to maintain the Water Utility Account [ i.e. if included in monthly rent or if Tenant is to pay monthly to the Town Office]. Please note all unrelated information will not be kept on file.
Property Manager Name
Property Manager Mailing Address with Postal Code
Property Manager Phone Number
Property Manager Email Address
Paperless Billing
1. Yes
2. No
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Acknowledgement

Applicant Acknowledgement
The undersigned hereby represents that he/she is the applicant or an authorized agent for the applicant, and that he/she has the authority to sign this contract for Utility Services consisting of: water, waste water, garbage collection, recycling collection and landfill. The applicant agrees to comply with all provisions of Bylaw 07-2009 and Utility Rates Bylaw 03-2016, including payment for all Utility services supplied by the Town of Slave Lake to the above service address until such time as the applicant or authorized agent requests in writing that the contract be terminated. It is understood that in the event of late payment or non-payment, in addition to other remedies the Town of Slave Lake may have, the amount owing for utilities service shall bear a penalty charge in accordance with the Municipal Government Act, Bylaw 07-2009, Utility Rates Bylaw 03-2016 and that non-compliance with the provisions of said By law may result in disconnection of utilities services by the Town of Slave Lake.

The applicant acknowledges that the failure to receive or the loss of a utility statement will not be accepted as a reason for non-payment. Deposits levied and paid in accordance with Town of Slave Lake, By law #07-2009 & Utility Rates By law #03-2016 will be retained for the duration of their Utilities Services agreement with the Town of Slave Lake.

The applicant hereby agrees to abide by the terms and conditions specified in the Town of Slave Lake Bylaw 07-2009 and Utility Rates Bylaw 03-2016.

When there are changes, please allow for at least five business days prior to the changes.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Please Note:
The individuals signing the application should only be the primary applicant and co-applicant as these individuals are financially responsible for the maintenance of the Utility Account. If the Optional section is completed an additional invoice will be sent to the Tenant(s) and Property Manager(s).
Electronic Signature of Applicant or Agent*
Date*
Date
Electronic Signature of Co-Applicant
Date
Date
Reply Email
The personal information requested on this form is being collected by Municipal Operation as required by the Town of Slave Lake, under the authority of the Freedom of Information and Protection of Privacy Act (FOIP act) Section 33(c). If you have any questions about the collection or use of your personal information, contact the Town of Slave Lake FOIP coordinator at 780-849-8000

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Slave Lake Alberta, Canada

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