Landlord Authorization Cancellation Form

Please accept this as your full and sufficient direction in regard to all properties that I / We own or manage. This direction will apply until further written notice is received by Waterloo North Hydro Inc. This direction will terminate any previous authorizations in regard to transferring responsibility for Hydro service for the following listed properties.
Property Address*
Property Address (Unit numbers must be included) Unit Number
Company/Account Holder Information
Company/Account Holder Name*
First Last
Owner(s) Name*
First Last
Contact/Authorized By (Please Print)*
First Last
Signature
Mailing Address*
Street Address City Province Postal Code
Phone Number*
Fax Number
Email Address*
Notes
Date*
MM slash DD slash YYYY

Property Address (Unit numbers must be included)	Unit Number

Company/Account Holder Information