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Water Connection Form (FOR BUSINESS CUSTOMERS ONLY)
Application Type (*)
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Services Applied For: (Please Tick your Required Services) (*)
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1. Company Details
Company Name (*)
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Registration Number (*)
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Company Phone Number (*)
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Company Tax Number (*)
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Company E-Mail Address
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Company Postal Address (*)
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Company Fax Number
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Country of Origin (*)
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2. Company Representative Details
Representative First Names (*)
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Representative Surname (*)
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Representative Personal Identity Number (*)
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Representative Work Telephone Number (*)
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Representative Home Telephone Number
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Representative Occupation (*)
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3. Place where supply is Required and Purpose
Physical Address Details
Area or Location
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Flat number
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House Number
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Street
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Purpose Required (e.g Domestic, Mining, Industrial, other specify) (*)
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4. Estimated Consumption (KL)
Average Per Day (KL)
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Maximum Per Hour (KL)
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Monthly Estimated Consumption (KL)
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Terms & Conditions
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I Agree to the Terms & Conditions (*)
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