Required fields are marked with asterisks (*)

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 are leaving in charge of your home or business may not have authority to contact Kitchener Utilities and schedule any chargeable work. In order for Kitchener Utilities to perform replacement service on your natural gas water heater or your natural gas appliances, your written authorization is required. Before you leave, please complete the form below to give prior authorization to someone in your absence in case your natural gas appliances require repair while you are away.

For further information, you can contact us at 519-741-2529.

Account number

Street Address

City

Province

Postal code

Country

First name

Last name

Home owner's phone number

Contact number when away (if available)

Email address

Start date

End date

First name of authorized

Last name of authorized

Phone number of authorized

Email of authorized

Additional comments