<form-template> <fields> <field type="paragraph" subtype="p" label="Please complete all sections of the form below to ensure we have the necessary information to accurately process your move-in or move-out utility bill. Only submit your meter reading on or after your move in/out date to have the most update to date meter reading." class="paragraph"></field> <field type="paragraph" subtype="p" label="THIS FORM IS FOR QUARTERLY WATER/SEWER ACCOUNT(S) IN GRUNTHAL AND KLEEFELD ONLY. For Manitoba Hydro Readings, please visit https://www.hydro.mb.ca/account/meters/submit-reading/." class="paragraph"></field> <field type="checkbox-group" label="Renter / Owner" class="checkbox-group" name="checkbox-group-1761836748502"> <option value="renter" selected="true">Renter</option> <option value="owner">Owner</option> </field> <field type="checkbox-group" required="true" label="Type of Update" class="checkbox-group" name="checkbox-group-1761836773553"> <option value="move in" selected="true">Move In</option> <option value="move out">Move Out</option> </field> <field type="text" subtype="text" label="Meter Reading" placeholder="Water Meter Reading (if available)" class="form-control text-input" name="text-1761836802370"></field> <field type="date" label="Date Reading Taken" class="form-control calendar" name="date-1761836872008" value="Date Reading Taken"></field> <field type="date" required="true" label="Move In / Out Date (Possession date change)" class="form-control calendar" name="date-1761836997216"></field> <field type="text" subtype="text" required="true" placeholder="First Name Last Name" class="form-control text-input" name="text-1761837032235"></field> <field type="text" subtype="text" placeholder="Secondary Owner (First Name Last Name)" class="form-control text-input" name="text-1761837043320"></field> <field type="text" subtype="text" required="true" placeholder="Street Address" class="form-control text-input" name="text-1761837178070"></field> <field type="text" subtype="text" required="true" placeholder="Mailing Address (PO box or Civic Address)" class="form-control text-input" name="text-1761837203171"></field> <field type="text" subtype="text" required="true" placeholder="Town" class="form-control text-input" name="text-1761837224217"></field> <field type="text" subtype="text" required="true" placeholder="Postal Code" class="form-control text-input" name="text-1761837239007"></field> <field type="text" subtype="text" required="true" placeholder="Phone Number (at least one)" class="form-control text-input" name="text-1761837252777"></field> <field type="text" subtype="text" required="true" placeholder="E-mail address (at least one)" class="form-control text-input" name="text-1761837266451"></field> <field type="checkbox-group" required="true" label="Final Bill by Email or Mail" description="Final bill only. Regular quarterly bills will come via Canada Post" class="checkbox-group" name="checkbox-group-1761837291765"> <option value="E-mail" selected="true">E-mail</option> <option value="Mail">Mail</option> </field> <field type="text" subtype="text" description="If final bill will be sent via Canada Post and your mailing address is different than where your quarterly bills were being sent to." placeholder="Forwarding Address (if Mail is chosen above)" class="form-control text-input" name="text-1761837356130"></field> <field type="textarea" label="Notes for our office" class="form-control text-area" name="textarea-1761837433966"></field> </fields> </form-template> Submit Submitting...
