Water Heater Rental Form

Service Address
Customer Name
Mailing Address
- None -
  • - None -
  • --- Canada Provinces ---
  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Nova Scotia
  • Northwest Territories
  • Nunavut
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  • Quebec
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  • Yukon
  • --- US Provinces ---
  • Alabama
  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • Armed Forces (AA)
  • Armed Forces (AE)
  • Armed Forces (AP)
  • California
  • Colorado
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  • District of Columbia
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  • Indiana
  • Iowa
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  • Kentucky
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  • Maine
  • Marshall Islands
  • Maryland
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  • Mississippi
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  • New Hampshire
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  • New Mexico
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  • North Carolina
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  • Northern Mariana Islands
  • Ohio
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  • Puerto Rico
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  • Tennessee
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  • Utah
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  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
I acknowledge and understand that I will automatically be enrolled in E.L.K.'s paperless billing known as E-Billing. 

When you sign up for E-Billing, you will have access to your bills in an electronic format via the E.L.K. website and your MyAccount. If at any time you wish to have a paper bill resumed or would liek to cancel E-Billing, please login to your account online to cancel. Please contact the office if you need assistance. 
Equipment Rented
New Customer is assuming responsibility of the rental hot water heater. 
There will be a $30.00 Occupancy Charge on your first bill. 
Sign above