CONTACT INFORMATION
First Name:* 

Last Name:* 

Daytime Phone Number:* 


Would you like to sign up for future e-mail notifications from Kitchener Utilities?* 
Yes, I give consent to receive free future communications from Kitchener Utilities.
No, thank you.
Note: If you would like to receive further communications, you must provide your e-mail address.
Email Address:


ADDRESS FOR WATER HEATER
Street # and Street Name:* 

Apartment or Unit #:

City/Province:

Postal Code: (N2G 4G7)* 


If you are requesting a new rental water heater installation please answer the following:

Current Water Heater Type:
Please select... natural gas electric oil none

Is your chimney usable:
Please select... yes no unknown

Number of people in your household:
Please select... 1 2 3 4 5 or more

Heating Source:
Please select... Boiler system electric baseboard electric forced air natural gas conventional furnace natural gas mid-efficiency chimney vented furnace natural gas mid-efficiency wall vented furnace natural gas high efficiency furnace oil wood unknown

Do you have a Jacuzzi Whirlpool tub?
Yes
No