Salt Water Electronic Application Form

Please note, all our electronic forms are processed by SignRequest.

By entering your email address below, you will receive an email with your signed documents once they are complete.

All fields marked with an asterisk (*) are required fields.

Please note, signing a form through e-signature is legally binding.

Application Type*

This is a required field.

E-mail*

This is a required field.

Legal Name (incl. middle names)*

This is a required field.

Person #1: Full Legal Name*

This is a required field.

Person #2: Full Legal Name*

This is a required field.

Company Name*

This is a required field.

Are you a previous AquaGib customer?

This is a required field.

Address where meter is required*

This is a required field.

Have you made an application for a supply of potable water for the above premises?

This is a required field.

Ticking this box, I acknowledge I have legal right to occupy the address*

This is a required field.

Mailing address is the same?

This is a required field.

Telephone*

This is a required field.

Description of premises*

This is a required field.

Supply Required (Date)*

This is a required field.

Upload ID Document*

This is a required field.

If you would like a PDF copy of the form to be completed and returned to us by post, please click here.