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2. Owner Name: *
4. Email:*
5. Phone Number:*
7. Utility Account Number: *
9. Important Information

   It is the customer's responsibility to notify the County of Wetaskiwin of a change to their email address. 

   In cases where an electronic invoice is not received, it remains the account holder's responsibility to ensure payment is received by the County of Wetaskiwin by the due date to avoid late payment penalties. 

11. 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, and 2) by signing in this alternate manner, your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I consent
13. Electronic Signature

    (Please type your name)

15. Freedom of Information and Protection of Privacy Act

    Section 33(c) of the FOIP Act authorizes the County of Wetaskiwin No. 10 to collect this personal information for the purpose of utility e-billing registration. If you wish to inquire about the collection, use, and disclosure of personal information, or if you have questions about correcting your personal information, please contact the FOIP Coordinator: foip@county10.ca; phone 780-352-3321 (ext. 2270); or, toll free at 1-800-661-4125.

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

    This field is not part of the form submission.

19. Submit

* indicates a required field