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Business Utility Sign Off Application

Moving Out

Do you own or rent the property?

Applicant information

Access your utility information anytime from the secure internet site by signing up at

By checking "I agree", the customer hereby contracts with the City of Medicine Hat for the utilities applied for, hereinafter referred to as the “services”. The Customer will pay to the City of Medicine Hat all amounts stated on the monthly utility billing for and in consideration of the services provided by the City of Medicine Hat, until such times as the customer applies in writing to have such services discontinued. I hereby agree to abide by all Utility Bylaws and Regulations now and hereafter in force. Pursuant to s. 33 (a) of the Freedom of Information and the Protection of Privacy Act, the personal information collected on this form is for the purpose of an enactment of Alberta. Questions regarding the collection and use of personal information can be directed to the FOIPP Head of Local Body at

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.

Do you agree?