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Release of Information

Tenant Information

Provide the name and identification of all the Tenants occupying the property. Please click on Add button to enter more tenants.

Owner/Landlord Information

Upon submitting this application, I authorize the City of Medicine Hat to provide information regarding my utility account to my landlord as indicated above. This information includes requests for a final read on my utility account, and/or information regarding disconnection of utility services.

This agreement remains in effect until the tenant moves from the address.

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.