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  2. mm/dd/yy

  3. mm/dd/yy

  4. mm/dd/yy

  5. By providing a second contact for the water account, you are authorizing the City of Lloydminster Water Department to discuss details of the water account with that person.

  6. 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.

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