Request utility service Form You must have JavaScript enabled to use this form. Required fields are marked with an asterisk (*) Customer Account Information Company Name (Commercial account only) First Name & Initial This field is required. Last Name This field is required. Phone Number This field is required. Email This field is required. Do you wish to give consent for another party to have full access to your account to conduct business on your behalf? Do you wish to give consent for another party to have full access to your account to conduct business on your behalf? Yes No First Name Last Name Contact Number Service Address Civic Number This field is required. Unit / Apartment Street Name and Type This field is required. City / Community This field is required. Province This field is required. - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Postal Code This field is required. Is the mailing address the same as the service (civic) address? Is the mailing address the same as the service (civic) address? Yes No Mailing Address Mailing Civic Number Unit / Apartment Street Name and Type City / Community Province - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon Postal Code Are you the property owner? * Are you the property owner? * Yes No Please select the effective date Previous Service with Halifax Water Have you ever had previous service with Halifax Water? Have you ever had previous service with Halifax Water? Yes No Previous location 1 City Province - Select -British ColumbiaAlbertaYukonSaskatchewanNorthwest TerritoriesManitobaNunavutOntarioQuebecNew BrunswickNova ScotiaPrince Edward IslandNewfoundland and Labrador Postal Code Add more previous location Yes No Previous location 2 City Province - Select -British ColumbiaAlbertaYukonSaskatchewanNorthwest TerritoriesManitobaNunavutOntarioQuebecNew BrunswickNova ScotiaPrince Edward IslandNewfoundland and Labrador Postal Code Terms and Conditions In submitting this form the customer acknowledges and agrees to the following conditions : The applicant agrees to take and pay for water, wastewater and stormwater service from Halifax Water in accordance with this application and to accept and pay for such services according to the Schedule of Rates, Rules and Regulations of Halifax Water. There is a $25.00 charge for the creation of an account which will be applied to your first bill. A security deposit may be required. Agree to Terms This field is required. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank
