New Account Set-Up

Complete this form to request a new Alliance Metering Solutions Account. Please call us at 519-888-5593 with any questions you may have

Customer Information
Customer Status*
Occupancy Date*
MM slash DD slash YYYY
Service Address*
Number, Street Name Unit Number City Postal Code
Primary Account Holder
Name*
Prefix First Last
Business Information*
Business Name
Operating As (if applicable)*
Operating as
Phone Number*
Email*
Driver's License or Photo Card number*
Date of Birth*
MM slash DD slash YYYY
Mailing Address*
Street Address City State / Province / Region Postal Code Country
Secondary Account Contact
Name
Prefix First Last
Phone Number
Email
Mailing Address
Street Address City Postal Code Country
Pre-Authorized Payment Registration
Alliance Metering Solutions customers may be required to pay a security deposit of at least $150 when opening a new account. If you register for Pre-Authorized Payment, the security deposit will be waived.
Would you like to register for Pre-Authorized Payment?*
- Yes (if yes, please complete the below information)
- No
Name of Financial Institution (FI)
Account Number
Transit Number

(branch: five digits) – (institution: three digits) e.g. 12345-123
Void Cheque or Bank Authorization Form*
Max. file size: 8 MB.
Please enclose a copy of a cheque marked ‘VOID.’ The cheque must be from the same account outlined above. Alternatively, you can include a signed Bank Authorization Form
This Agreement is dated:*
YYYY dash MM dash DD
Primary Account Holder Signature*
I agree to the Terms and Conditions set out in this agreement*
I agree to the Terms and Conditions set out in this agreement. Note: See the link below to read the Terms and Conditions
CAPTCHA

Terms and Conditions set out in this agreement.

New Account Set-Up

Customer Information

Primary Account Holder

Secondary Account Contact

Pre-Authorized Payment Registration

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