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Vendor Direct Deposit Application

Payment will be posted on or around the 15th and 30th of each month based on the terms of the invoice and Selwyn Township management approval.

You may terminate this arrangement at any time. Please advise the Selwyn Finance Department at least 10 business days prior to next expected payment. The Change of Banking Information and Cancellation forms can be obtained from the Finance Department.
If your banking information is rejected upon processing, a cheque will be issued and the information will be removed from your account.

I/we hereby authorize the Township of Selwyn, through the Canadian Imperial Bank of Commerce, to deposit our payments to the bank account as indicated below. I/we will advise Accounts payable of any change in this regard and the authorization is to remain in effect until I/we cancel it in writing, with the sign off from authorized officers.

Vendor Company Information

Company Name:

Company mailing address:

Receivable Email address:

These services are for:

Personal use

Business use

Vendor Company Officers

Name:

Title:

Phone:

Fax:

Phone:

Fax:

Signature:

Clear

Signature:

Clear

Date requested:

Banking Information

Please upload a void cheque or banking information form provided by your financial institution

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