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PRE-AUTHORIZED PAYMENT AGREEMENT

Property owners now have the option to choose one of two pre-authorized payment plans for taxes and an instalment plan for water accounts that offer the convenience of having no cheques to write, no worries about overdue payment fees, no large lump sum payments and no line-ups at the bank or municipal office. To Enrol please complete:

Property Tax - Roll Number:

Minimum characters: 5

Additional Property Tax - Roll Number

Minimum characters: 5

Water - Account Number:

Minimum characters: 11

Additional Water Account Number:

Minimum characters: 11

Owners Name(s) as listed on your account(s):

Mailing Address

City

Province

Postal Code

Type of Service

Business

Personal

Phone Number:

e-mail:

Instalment Plan and/or Monthly Plan

Monthly Payment Plan – For Property Taxes Only – starting the month of February through the month of November. An electronic debit will be drawn on your bank account on the last business day of every month based on your prior year’s annualized taxes divided by 10. A final reconciliation amount will be adjusted in the month of August. You can join the plan at any time during the year - the monthly amount will be adjusted accordingly.

Instalment Plan (Due Date) – an electronic debit in the amount of the tax / water instalment due on the particular due date, as shown on the tax / water billing provided by the Township, will be drawn on your bank account on the instalment due date.

Banking Information

Attach to this agreement – the top of your Account Statement showing the Account Holder’s names, the Branch address, and the Account Number; or a voided cheque. NOTE: All account holders must sign this agreement.

Upload Banking Information

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Supplementary Tax billings are not covered by these plans. They must be paid independently. This plan will be terminated and Returned Item fees will apply if a debit is returned by your bank. See reverse side for cancellation and reimbursement details.

I(we), the account holders, authorize Village of Oil Springs and my(our) financial institution to debit my(our) account for property taxes and/or water utility billings under the terms and conditions as indicated above and agreed to by me(us) until such time as written notice to the contrary is given by me(us) to the Village. Each debit shall be the same as if I(we) had personally issued a cheque payable to the Village. The Village will provide ten (10) days written notice of the amount of each regular debit including changes to the amount.

Name of Applicant

Signature

Clear

Name of Applicant

Signature

Clear

Date

The personal information on this form is collected under authority of the Municipal Act, SO 2001, and will be used only for the purpose of administrating the pre-authorized payment plans offered by the Municipality. Questions about the collection of personal information should be directed to the Freedom of Information and Privacy Coordinator, Village of Oil Springs Clerks Office.

Cancellation of Agreement

This authority is to remain in effect until Village of Oil Springs has received written notification from you regarding its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided on this form. You may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting www.cdnpay.ca.

Reimbursement Statement

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, you may contact your financial institution or visit www.cdnpay.ca.