Bulk Water Access Permit


ACCOUNT INFORMATION
*Customer Full Name
*Contact Full Name
*Contact Email
*Contact Phone	Extension
*Service Street Number
*Service Street Name
Unit Number
SERVICE INFORMATION
*Date to Commence
*Date to Terminate
*Purpose of Use
*Charge per Month ($)
*# of Cards Requested
The Owner of the Permit will continue to be billed the monthly fee until the bulk water access card has been returned to PUC Services at 500 Second Line E, Sault Ste. Marie, Ontario $50 Administration Charge for any lost or damaged access cards If you have any questions please call 705-759-6522 or email customer.experience@ssmpuc.com
Authorization	By submitting this form you authorize PUC to bill you the monthly fee stated above. Customer Care will contact you when your card is ready for pick-up.
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