Utility Services account application form

Personal information provided is collected by Leduc County under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act (the FOIP Act) and we will protect it in accordance with Part 2 of that Act. We will use it to manage your account with us, and contact you if necessary. Should you require further information about collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780‐770‐9251 or foip@leduc‐county.com.

Property owner information

Owner name *

Phone number *

Cell phone number

Owner address *

Town/city *

Province *

Postal code *

Owner email address

Fax

Do you want to receive electronic invoices? *

Yes

Tenant information (if different from owner)

Tenant name

Phone number

Cell phone number

Tenant address

Town/city

Province

Postal code

Tenant email

Fax

Utility services effective date *

Second waste bin request (at an additional cost)

Yes

Legal land description

1/4

Section

Township

Range

West of

Roll number

Lot

Block

Plan

Subdivision/hamlet

Service address *

Note

Any residential property within New Sarepta, Diamond Estates, Lukas Estates, Royal Oaks, Churchill Meadow, Irvine Creek and Nisku Hamlet will be provided with one waste bin.
In consideration of Leduc County issuing a waste container, the parties agree to the following:

The owner is responsible for the replacement of lost, stolen or damaged bins unless such damage is the result of collection contractor activity.
The costs assigned to bin replacement by the current contracted service provider shall be recoverable from the owner as an add-on value to normal service invoicing.
The bin will remain at the above-referenced property regardless of changes in ownership or occupant.
This agreement or benefit thereof cannot be assigned.

Electronic billing

It is the customer’s responsibility to notify Leduc County 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 Leduc County by the due date to avoid late payment penalties.

I/we, the registered owner(s) of the aforementioned property do hereby request that a copy of all utility bills issued for the said property be forwarded to the above-listed mailing addresses. The registered homeowner is responsible for all account balances as per Municipal Government Act section 42(1) and balances will be transferred to the owner’s tax roll as per Municipal Governement Act section 553(1). The registered homeowner agrees to abide by all Leduc County bylaws.

Property owner signature *

OFFICE USE ONLY

Account number

Tax roll number

Date of service

Book number

Page number

Serial number

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Utility Services Account Application