Tenant Information Form

Tenant Information Form

Residential Tenant Occupancy

Mail Tenant Applications to: City of Brantford, Customer Services – Utilities, 220 Colborne St., PO Box 515, Brantford, ON N3T 6L6

Email Scanned Tenant Application to:

customerservices@brantford.ca

Telephone: 519-756-1360 Fax: (519) 753-9884

TENANT

______________________________________________________________________________________________

I (We)

______________________________________________________________________________________________

Please print the name(s) of the tenant(s)

___________________________________________________________________________________

Service address location:

Occupancy Date: _________________________________Landlord name: ______________________________________________________________

Declare as follows that:: I (We) are the Tenant(s)/Occupant(s) of the property at the above noted Service Address.

1. I (We) acknowledge that we are responsible to pay, jointly and severally, all water & sewer bills when they are due for the above noted service address for the

period I(we) are tenants/occupants.

2. I (We) understand that the City of Brantford will pursue all its legal remedies against me (us) to collect any unpaid balances outstanding on my (our) account.

3. I (We) acknowledge that we are responsible to notify the City of Brantford of all tenant(s), occupant(s), and/or any tenancy changes.

4. I (We) understand that the City of Brantford may require a minimum security deposit as per the Water and Wastewater Billing & Collection Policy and the account

will be charged a $30.00 Account Set-up / Change of Occupancy fee.

5. I (We) agree to the City of Brantford mailing late payment or collection notices to the Owner(s) of the property, and may communicate to my landlord the amount of

the arrears on the account.

6. I (We) agree to give the City of Brantford free access to the premises during regular business hours to allow the City to read, repair, remove and replace meters.

7. I (We) acknowledge that the City has the right to cut off the supply of utilities and to remove the meter or related fixture(s) whenever the bill for these utilities is in

arrears, or I (we) are in breach of this agreement.

8. I (We) agree to the City of Brantford obtaining my personal credit information, and disclosing my personal credit information to and from other lenders, credit bureaus

or other credit reporting agencies.

9. I (We) acknowledge and agree that this shall be the City of Brantford’s full and sufficient authorization to use

the information supplied to assist in the collection of overdue accounts. The City of Brantford reserves the right to add a service charge (per the City’s Fee

& Charges By-law) plus the cost of running a credit report if my (our) account is in arrears.

Tenant(s) Work Telephone:

Date of Birth (mm/dd/yy)

Tenant(s) Home Telephone:

Driver’s License #:

Tenant(s) Cellular Telephone:

Place of Employment:

Tenant(s) Email Address:

Tenant(s) previous address in Brantford was:

SIGNATURES:

– All adult occupants responsible to pay fees and charges at this service address

Tenant Name(s) and Signature(s)

Date

Personal information collected is pursuant to the Municipal Freedom of Information and Protection of Privacy Act, as amended, under the authority of Part XII of the

Municipal Act, as amended, and will be used for the purposes of administration of the municipal water and wastewater services. Questions about this collection should be

directed to the City Clerk’s Division, City of Brantford, 100 Wellington Square, P.O. Box 818, Brantford, Ontario, Canada N3T 5R7