Village of St. Peter's/St. Peter's Samsonville and Area Water Utility Customer Information Form
The survey will take approximately 6 minutes to complete. Please complete so we have the most up to date information on file. All information provided will be solely used by the Village of St. Peter's & St. Peter's, Samsonville and Area Water Utility to maintain accurate customer information. Information is not shared with third parties.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number if Applicable
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Would you be interested in receiving your quarterly water & sewer bills via email? By selecting yes below, your bills will be sent to the email listed above?
Yes I would like to receive my bills via email
Yes but I would also like to receive paper copies in the mail
No thank you, please continue to send my bills via mail
Would you be interested in receiving notifications regarding water service interruptions(hydrant flushing, water service repairs, planned water service maintenance) via email?)
Yes I would like to receive notifications via email
No thank you, I do not want to receive water service interruption notices?
How many people reside in your home? (Applicable to residences only)
How old is your home? (Applicable to residences only)
If your home is 50 years or older, would you be interested in having your water tested for lead/copper testing?) The St. Peter’s, Samsonville and Area Water Utility is required annually to conduct lead and copper sampling in 10 high risk homes connected to the water system. High risk homes are homes older than 1975 and/or homes containing lead pipe, copper pipe with lead solder and/ or lead containing brass fittings These tests are to be conducted on a yearly basis by the Water Utility. Tests are usually conducted in August each year. Any homes to be tested must be in St. Peter’s, Samsonville or French Cove. There is no cost to the participants who volunteer for testing.
Before saying yes, i would like more information
Yes I would be willing to have my water tested!
No thank you, not interested at this time
My home is less than 50 years old, can I still get my water tested?
How would you like to receive information from the Village of St. Peter's/St. Peter's, Samsonville and Area Water Utility?
Via Email
Via Telephone
Via Mail
Website/Facebook pages
Radio, Newspaper Ads if applicable
Posters in local businesses
Thank you, I am not interested in receiving further information at this time!
Submit
Should be Empty: