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Residential Water Filling Station Payment Form

Use this form to request an account and receive one or more electronic FOB(s) to access the City of Nanaimo water filling station for residential purposes. Please contact PW.Secretary@nanaimo.ca for more information.

Water being used for:



Number of FOB(s):





TERMS OF WATER FILLING STATION

  1. The applicant hereby understands and agrees to be fully responsible for the safe and proper transport of water for domestic purposes.
  2. The applicant further hereby agrees to release, indemnify and keep indemnified the City, and its employees and officers from any and all claims, costs, damages, losses, actions, causes of action, suits, demands, fees, fines, expenses or losses whatsoever, including economic loss, arising from or in any way connected with the supply or sale of water by the applicant.
  3. The applicant further hereby agrees to abide by Water Use Restrictions and other Water Notices as enacted by the City.
  4. The applicant is responsible for any damages to the City of Nanaimo equipment/property (including roads).
  5. The City reserves the right to discontinue water supply at any time without notice.
  6. The water consumption rate shall be charged as per the City of Nanaimo Bylaw #7004.16.
  7. The applicant shall notify the City (Public.WorksInfo@nanaimo.ca) immediately of lost or stolen card(s). Replacement FOB cards are available at the City of Nanaimo, Public Works Office counter (see Bylaw #7004.16 for fees). Unused card balance can be refunded or credited to a new card.

I, the applicant, have read and agree to the above terms:

The administration fees (application form and FOB card) are charged as per Bylaw #7004.16. The fees are non-refundable and are due immediately after application approval. Refer to the following page for further details on Commercial Trucks information. The Operator FOB card will work at both Water Filling Stations.

Collection and use of your personal information
Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA.  Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at (250) 755-4405, or via email at foi@nanaimo.ca.

Last updated: August 9, 2023

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Collection and use of your personal information

Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA. Questions about the collection of your personal information may be referred to the Legislative Services Department at 250-755-4405, or via email at foi@nanaimo.ca. Please also see our Privacy Policy.