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Connection Transfer Form

  1. Full Colour Logo - Vertical.png_thumb.png

  2. If you have any questions about your water account please contact the Water Desk through phone (780-875-6184 Ext. 2125) or email (

  3. First, Last

  4. Street/City/Province

  5. Street/City/Province

  6. Home

  7. Cell

  8. Work

  9. Complete if "Tenant" is selected above

  10. By submitting a secondary contact, I authorize the City of Lloydminster to share details of this water account with my second contact.

  11. First, Last

  12. Should be a family member not living with the account holder. In case of an emergency and we are unable to reach you, the City of Lloydminster Water Department will contact your reference to inform them of the emergency.

  13. A deposit of $250 will be charged for any account in a Tenant's name, as well as a service charge of $60 is required before utility services will be connected. A representative from the Finance department will contact you within 24 hours of your submission of this form to take your payment information. As per bylaw 26-2016, all service addresses must be connected to The City of Lloydminster Billing System. An account can either go in the homeowner's name, or the tenant's name with the homeowner receiving a copy.

  14. "Your name, home phone number, home address, postal code and date of birth are collected under the authority of section 25 of the Local Authority Freedom of Information and Protection of Privacy Act. This information will be used for collection and account information purposes." If you have any questions about the collection, contact the FOIP Head at 780-871-8328.

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  16. This field is not part of the form submission.