ERTH Solutions New Account Application

Welcome to ERTH Solutions, a complete billing provider acting on behalf of municipalities. We look forward to serving you.

Please note that all personal information is collected, retained and disclosed in accordance with our Privacy Policy. Mandatory fields are indicated with a red astericks (*)
Account Name*
Contact Name
Note: If different from above
First Last
Work Phone
Extension
Home Phone*
Cell Phone
Email Address*
Enter Email Confirm Email
Employer*
Are you a returning customer?*
- Yes
- No
Service Address*
Street Address Address Line 2 City Province Postal Code
Choose which best describes you*
- Owner/Landlord
- Tenant
Owner/Landlord Name
First Last
Owner/Landlord's Phone
Owner/Landlord Email
Will your mailing address be different from your service address?*
- Yes
- No
Mailing Address
Street Address Address Line 2 City Province Postal Code
Please note that Date of Birth is required for each adult occupant listed. This information is used for security identification purposes, as outlined in our Privacy Policy
Date of Birth*
MM slash DD slash YYYY
Will there be an additional adult living with you that should be listed on the account?*
- Yes
- No
Additional Adult Name
First Last
Additional Adult Phone*
Additional Adult Email*
Additional Adult Date of Birth*
MM slash DD slash YYYY
Additional Adult's Employer*
Move In Date*
If date falls on a weekend/holiday, service will be done on the next business day

MM slash DD slash YYYY

Contact Customer Service

Monday – Friday: 8:30 a.m. to 4:30 p.m.

1-877-485-6050

customerservice@erthsolutions.com

PO Box 271, Dorchester, ON N0L 1G0

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