Water Discounts Form

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If you require assistance to fill in this form, please contact City of Medicine Hat Customer Service (first floor, City Hall, 580 1 Street SE) at 403.529.8111.

Please correct the field(s) marked in red below:

1
Customer Name
 *
2
Customer Address
 *
3
Customer Phone Number
 *
4
E-mail Address
5

Water Meter Number What is this?
Please enter the seven digits following BW.

 *
6
Date customer started leaving the water running
 *
7
Customer acknowledges this information will be verified.
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