Pre-Authorized Payment Plan Authorization Form

Please fill out the below form in its entirety in order to have Pre-Authorized payments set up for your property taxes. You may choose to pay monthly, or only on tax installment due dates. You must also provide either a picture of a void cheque, or pre-authorized debit form from the bank for the bank account you would like payments to be taken from. If the bank account is in more than one name, all parties must sign granting permission for the payments to be made.

Pre-authorized Payment Plan Authorization Form

Name on Tax Bill

Assessment Roll Number

Mailing Address

Address 1

Address 2

City

ZIP / Postal Code

State / Province

Phone:

Financial Institution Information

Name of Financial Institution

Address of Financial Institution

Address 1

City

ZIP / Postal Code

State / Province

Transit Number

Bank Number

Account Number:

Type of Plan

Savings

Chequing

Select your option

Monthly (15th)

Installment Due Date

Terms and Conditions

I/we the undersigned hereby authorize the Township of Howick and the financial institution designated below to begin deductions for my/our preauthorized payment for property taxes.

It is acknowledged that in order to revoke/cancel this agreement the Customer must provide written notice to the Township of Howick 10 days prior to the payment date.

The Township of Howick may also revoke/cancel this agreement upon written notice to the Customer or after 2 missed payments.

This Authorization applies only to a method of payment and cancellation of this Authorization does not mean that the Customer’s contractual obligations to the Township of Howick are ended.

The Customer will notify the Township of Howick promptly in writing if there is any change in the information below.

Returned payments are subject to the “returned cheque fee” as per Fees and Charges By-law.

I have read, understand and agree to the terms listed above

Authorized Signatures

For Joint Accounts, all parties must sign this

Pre-Authorized Payment Plan Authorization Form

Pre-authorized Payment Plan Authorization Form

Get In Touch

Leanne Marks Deputy Treasurer