Pre-Authorized Payment Authorization Form - Water & Sewer

Please fill out the form below if you wish to set up automatic water/sewer payments with the Township of South Stormont.

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Terms and Conditions

1. I(we) authorize the Township of South Stormont (Payee) to debit my(our) account as indicated on the attached “VOID” cheque, or account information provided by a bank official, under the terms and conditions agreed to by me(us) with the Payee until such time as written notice to the contrary is provided.

2. I(we) acknowledge that delivery of my(our) authorization to the Payee constitutes delivery by me(us) to the branch of the financial institution at which I(we) maintain an account, and that such financial institution is not required to verify that the payment(s) are drawn in accordance with this authorization.

3. I(we) will notify the Payee in writing of any changes in the account information or termination of this authorization 14 days prior to the next due date of the preauthorized debit.

4. A service charge will be applicable, and added to my(our) tax account, in the event any payment is not completed by the financial institution due to insufficient funds or for any other reason.

5. The Payee may cancel or suspend enrollment in the pre-authorized payment plan after two returned payments.

6. I(we) guarantee that all persons whose signatures are required to sign on the account have signed this authorization below.

7. I(we) agree to comply with the Rules of the Canadian Payments Association or any other rules or regulations which may affect the services described herein, as may be introduced in the future or are currently in effect and I(we) agree to execute any further documentation which may be prescribed from time to time by the Canadian Payments Association in respect of the services described herein.

8. I(we) understand and agree to the foregoing terms and conditions.

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Personal information contained on this form is collected under the Municipal Freedom of Information and Protection of Privacy Act and will be used to respond to your request. Questions about this collection should be directed to the Director of Corporate Services at 613-534-8889 ext.201.