Form Centre

2. Print off a blank Utility Connection Application form if you do not wish to submit your form electronically:
   Utility Connection Application
4. Effective Date:*
   Effective Date:
5. Check one:

   1. Residential
   2. Commercial
6. Services:

   1. Water
   2. Sewer
   3. Garbage
8. Property Owner's Name:
10. Service Address:
12. City:
13. Province:
14. Postal Code:
16. Mailing Address (if different from above):
18. City:
19. Province:
20. Postal Code:
22. Phone:
23. Phone:
24. Phone:
26. Emailed bills:

    1. Yes, I would like to have my utility bills emailed
27. Email address:
29. The undersigned agrees to pay for all utility services supplied by Red Deer County. An application fee of $30 must be paid in full no later than the due date of the first bill to avoid possible service disconnection without further notice.
    
    The undersigned hereby represents that he/she is the applicant or that he/she is an authorized agent for the applicant and that he/she has the authority to sign this contract for utility services. The applicant agrees to pay for all utility services supplied by Red Deer County to the above service address until 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 Red Deer County may have, the amount owing for utilities service shall bear a penalty charge in accordance with the Municipal Government Act and Red Deer County Fee Bylaw. The applicant acknowledges that failure to receive or loss of a utility bill cannot be accepted as a reason for non-payment. Customers wishing to close their accounts must provide written notice to the County of the intent to disconnect the utility service at least five (5) working days prior to closure of their account.
    
    The applicant hereby agrees to abide by the terms and conditions as specified in Red Deer County's Fee Bylaw excerpt as follows:
    
    "In the event a utility bill remains unpaid after the date fixed for payment, a penalty of one point five percent (1.5%) will be added to said account for the first month and one point five percent (1.5%) for each month following. The one point five percent (1.5%) interest charge will be calculated at the date of the utility bill on the arrears as at that date.
    
    Any utility bill remaining unpaid under this bylaw will constitute a debt owing to the County and is recoverable by any or all of the following methods, namely:
    1) by the amount owing being transferred to the owner's tax roll after ninety (90) days of non-payment;
    2) by the action in any Court of competent jurisdiction.
    
    At the discretion of Red Deer County, pursuant to Red Deer County's Waterworks Bylaw, the County may discontinue service for non-payment of the charges levied pursuant to this Bylaw."
31. "The Owner hereby requests the supply of utility services to the property described above."*

    1. I agree
33. 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.
    3) You may still be required to provide a traditional signature at a later date. *

    1. I agree
35. Electronic Signature:
37. Please note that the personal information requested in this form is protected under the Freedom of Information and Protection of Privacy Act (FOIP). Collection of the personal information is authorized under FOIP, Section 33(c) and is required to facilitate the connection of a utility service. If you have any questions regarding FOIP, please phone 403.350.2150 and ask for the FOIP Coordinator.
Leave This Blank:


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

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field