Kitchener Utilities: Online Form

Authorization Form for Billable Services in my Absence

Going Away?

Whether you are going away for a week or six months, you need to know the person you leave in charge of your home or business may not have the authority to contact Kitchener Utilities and schedule any chargeable work.

In order for Kitchener Utilities to perform replacement service on your rental water heater or service your natural gas appliances, your written authorization is required.

Before you leave, just complete the form below to give prior authorization to someone else in case your natural gas appliances should require repairs in your absence.

For further information you can contact us 24/7 at 519-741-2529.
Please note: * indicates that the field is mandatory

Account Number:*

Are you the:*
Please note, you must be the registered owner to sign up for this service.Tenant
Registered Owner
First Name:*

Last Name:*

Home Phone Number:*

Contact Phone Number when away: (if available)

Email Address:

Service Address Information

Street # and Street Name:*

Apartment or Unit #:

I provide authorization to the person listed below to schedule chargeable services to my property in my absence from:*
(yyyy/mm/dd)
to:*
(yyyy/mm/dd)

First Name:*

Last Name:*

Phone Number:*

Additional Comments:

Would you like to sign up for further email notifications?*
Yes
No, thank you