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Lakefield Water and Sewer: Pre-Authorized Payment (PAP)

Lakefield Water and Sewer Pre-Authorized Payment (PAP)

Please use this form to:

- enroll in a new pre-authorized payment (PAP) plan
- change your existing banking information
- cancel an existing plan

NOTE: If two payments are returned by the bank this agreement will be terminated. There is a charge of $25.00 per returned item.

All plan additions, changes or cancellations must be received at least 5 business days prior to the next scheduled withdrawal.

Applicant is:

Property Owner

Tenant

Please select an option:

Start a new PAP plan

Change your plan type

Change your banking information for an existing plan

Change the plan type and banking information for an existing plan

Cancel an existing plan

Property address (including unit identifier, if applicable):

Account Number:

Full name:

Phone number:

Email:

Would you like to enroll your account in electronic billing?

Yes

I am already enrolled

Terms and Conditions

I/We authorize the Township of Selwyn to debit my/our account as indicated on the attached "VOID" cheque or banking informing information under the terms and conditions agreed to by me/us with the payee until such time as written notice to the contrary is given.

I/We will notify the Payee is writing of any changes in the account information or termination of this authorization no later than 10 days prior to the next scheduled withdrawal.

I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/We have the right to receive reimbursement for any debit that is not authorized or is not consistent with this agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution or visit www.cdnpay.ca.

I/We warrant that all persons whose signature(s) are requested to sign this account have signed the agreement.

Personal information on this form is collected under the authority of the Municipal Act 2001, c25 and will be used to process the Pre-authorized Payment Plan application. The personal information submitted will be used to provide you with information or updates on services or activities that the Township of Selwyn delivers under the Municipal Act or other legislation. Questions about the collection of this personal information should be directed to the Clerk.