Required fields are marked with asterisks (*)

Water Filling Station Application

Use this form to request an account and receive a customer ID and PIN to access the City of Camrose water filling station. Please contact Financial Services at 780.672.4426 or at bulkwater@camrose.ca for more information.

Contact Name

Business Name (if applicable)

Address

City/Town

Postal Code

Phone Number

Email Address

TERMS OF WATER FILLING STATION

The applicant hereby understands and agrees to be fully responsible for the safe and proper transport of water for domestic purposes.

The applicant further hereby agrees to release, indemnify and keep indemnified the City, and its employees and officers from any and all claims, costs, damages, losses, actions, causes of action, suits, demands, fees, fines, expenses or losses whatsoever, including economic loss, arising from or in any way connected with the supply or sale of water by the applicant.

The applicant further hereby agrees to abide by Water Use Restrictions and other Water Notices as enacted by the City.

The applicant is responsible for any damages to the City of Camrose equipment/property (including roads).

The City reserves the right to discontinue water supply at any time without notice.

The water consumption rate shall be charged as per the City of Camrose Annual Fees and Charges Bylaw.

Unused card balance can be refunded or credited to a new account.

I, the applicant, have read and agree to the above terms:

I agree

The information on this form is collected solely for the purpose of administering the City of Camrose’s Water Filling Station program. Where applicable, the information shall be administered in accordance with the Freedom of Information and Protection of Privacy Act (FOIP).