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Bulk Water Fill Station

Customer Set Up

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used for the purpose of administering the Municipality of Lakeshore bulk water fill service.

Name of Customer

Contact Name

Mailing Address

PO Box/ Unit/ Rural Route

City / Town

Province

Postal Code

Telephone Number

Email Address

Please enter a 4 digit PIN you would like

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Bulk Water Fill Station

Customer Set Up

I'd Like To

Apply or Register For

Pay For

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