<form-template> <fields> <field type="checkbox" label="ARE YOU: HOME OWNER " class="checkbox" name="checkbox-1703105475356"></field> <field type="checkbox" label="ARE YOU: TENANT" class="checkbox" name="checkbox-1703105517839"></field> <field type="date" required="true" label="Date of Possession " class="form-control calendar" name="date-1703100544907"></field> <field type="text" subtype="text" required="true" label="Service Address " description="Street name / House Number " class="form-control text-input" name="text-1703099831464"></field> <field type="header" subtype="h2" label="HOME OWNER INFORAMTION " class="header"></field> <field type="text" subtype="text" required="true" label="Name " class="form-control text-input" name="text-1703100066397"></field> <field type="text" subtype="text" required="true" label="Mailing Address" class="form-control text-input" name="text-1703100122060"></field> <field type="text" subtype="text" required="true" label="Phone Number " class="form-control text-input" name="text-1703100163682"></field> <field type="text" subtype="text" label="Email" class="form-control text-input" name="text-1703100180330"></field> <field type="header" subtype="h2" label="TENANT INFORMATION" class="header"></field> <field type="text" subtype="text" label="Name" class="form-control text-input" name="text-1703100272886"></field> <field type="text" subtype="text" label="Mailing Address" class="form-control text-input" name="text-1703100306631"></field> <field type="text" subtype="text" label="Phone Number " class="form-control text-input" name="text-1703100320691"></field> <field type="text" subtype="text" label="Email" class="form-control text-input" name="text-1703100332166"></field> <field type="header" subtype="h3" label="ARE YOU CURRENTLY PAYING UTILITY AT ANOTHER LOCTION? IF SO, PLEASE FILL OUT THE FOLLOWING SO WE ARE ABLE TO PROVIDE YOU WITH A FINAL WATER BILL." class="header"></field> <field type="text" subtype="text" label="ACCOUNT NUMBER (IF YOU KNOW)" class="form-control text-input" name="text-1708441453604"></field> <field type="text" subtype="text" label="STREET ADDRESS " class="form-control text-input" name="text-1708441404754"></field> <field type="checkbox" label="By making this request for service, I acknowledge the Municipality of Killarney Turtle-Mountain will provide the home owner with copies of all correspondence related to the service, including, but not limited to invoices, requests for payment and disconnection notices. I further acknowledge that the Municipality of Killarney Turtle-Mountain will release status of the account to the homeowner upon request. (Type &quot;yes&quot; if you agree to terms) *" class="checkbox" name="checkbox-1703105609995"></field> <field type="text" subtype="text" required="true" label="Signature (Type your name):" class="form-control text-input" name="text-1703100498943"></field> </fields> </form-template> Submit Submitting...
