This form should be completed and submitted at least three working days prior to the required final meter reading date.

All fields marked with an * are mandatory.

I am completeing this form because: *

I am moving out (sold property)

I am moving in (purchased property)

I am the: *

Property seller

Property purchaser

Property seller's or purchaser's legal representative

Property and account details

Property Address *

Account Holders Name *

Account Holders Name

First Name

Last Name

Account Number *

Contact Details of the Seller

Name of Seller *

Name of Seller

First Name

Last Name

Phone Number *

Mobile/Home

Postal Address *

Email *

Contact Details of the seller's legal representative

Company Name *

Representative's Name *

Representative's Name

First Name

Last Name

Phone Number *

Mobile/Office

Postal Address *

Email *

PLEASE NOTE A NEW ACCOUNT CANNOT BE CREATED UNTIL THE NEW OWNER'S INFORMATION IS PROVIDED AND AS SUCH THE PRESENT ACCOUNT HOLDER WILL BE LIABLE FOR WATER AND WASTEWATER CHARGES UNTIL THE NEW ACCOUNT HOLDER'S INFORMATION IS PROVIDED TO PINE HARBOUR WATER.

Contact details of the purchaser

Name

First Name

Last Name

Phone Number *

Mobile/Home

Postal Address *

Email *

contact details of the purchaser's legal representative

Company Name *

Representative's Name *

Representative's Name

First Name

Last Name

Phone Number *

Mobile/Office

Postal Address *

Email *

Let us know your contact details so we can confirm the meter reading and contact you in case we have to reschedule the reading.

Your Name *

Your Name

First Name

Last Name

Phone Number *

Mobile/Home

Email *

Billing Address *

Required Reading Date *

Please allow three working days

I am the account holder or I have been nominated by the account holder to request a final meter reading with the details above, and I accept the Pine Harbour Water general terms and conditions for this service *