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Pre-Authorized Payment Plan Enrollment Form

TERMS & CONDITIONS:

• Once you have enrolled in a payment plan, you will automatically remain enrolled in the program until you choose to withdraw from the plan.

• If, for any reason, you wish to be removed from the payment plan, your banking information changes, or you are moving (even if it is within the Township), you must notify the Finance department in writing a minimum of ten (10) business days prior to the next scheduled pre-authorized payment withdrawal. This must be done by completing a PAP Cancellation Form or a Banking Chan ge Form. Failure to inform the Township of a change in this timeline may result in an additional withdrawal.

• If, FOR ANY REASON, a payment is returned by your bank, you will be subject to an NSF fee as outlined in the current fees and charges by-law. A letter will be sent to you outlining the details of the returned payment along with the deadline and details of the amount to be repaid on your account. If three (3) payments are returned within a one (1) year period, your enrollment in the Pre-Authorized Payment Plan will be terminated.

• Any additional billings issued during the year are not eligible for payment through a payment plan and are due and payable separately to the Township on the dates as shown on the bill. Failure to pay a bill can result in your removal from the payment plan.

Applicant First Name

Applicant Last Name

Phone Number

Email Address

Select the account you would like to enroll in a payment plan

Property Tax

Water/Wastewater

Banking Information – Please upload a VOID cheque or a direct deposit form from your financial institution

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

By signing this form, I hereby declare:

I authorize the Township of Tay to withdraw payments from my bank account;

I am a registered property owner;

I have attached my banking information.

I understand the Terms and Conditions as outlined above.

Applicant Signature

Clear

Notice of Collection/Use/Disclosure

Personal information contained on this form/document/application is collected pursuant to Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose for which it was collected. Questions about this collection should be directed to the Clerk of the Township of Tay.

This authorization form will be submitted by email to taxinfo@tay.ca.

Notice of Cancellation

To cancel pre-authorized payments, please complete the online cancellation form at least 10 business days before the next withdrawal.