Form Center

* indicates a required field

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. Protection of Privacy Act

    The personal information collected through this Register for Utility E-Billing form is for the purpose of managing requests for registration for utility e-billing. This collection is authorized by Section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321.

    
    

Leave This Blank:


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

    This field is not part of the form submission.

18. Submit