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Pre-Authorized Payment Plan Sign Up

Please submit this form if you would like to enroll in pre-authorized payments for taxes, utility and/or general accounts receivable accounts (includes marina, dog licences, waste management).

Note: accounts must be paid in full before setting up a pre-authorized payment plan. View the complete pre-authorized payment terms before signing up.

For a joint account, all depositors must sign if more than one signature is required on cheques.

Account Holder First Name:

Account Holder Last Name:

Property Address:

Email:

Phone Number:

Is your mailing address different than the property address? Is your mailing address different than the property address?

Yes

Choose applicable plan(s):

Tax Plan: Tax Plan:

Due Date Plan

Monthly Plan

Property Roll Number:

Date to Start Withdrawals:

Utility Plan: Utility Plan:

Due Date Plan

Monthly Plan

Utility Customer Number:

Date to Start Withdrawals:

General Accounts Receivable Plan: General Accounts Receivable Plan:

Due Date Plan

Accounts Receivable Customer Number:

Date to Start Withdrawals:

Please upload a void cheque or a form from your financial institution which includes your banking information.

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

I/We authorize the Municipality of Kincardine and financial institution designated (or any other financial institution I/We may authorize at any time) to begin withdrawals as per my/our instructions for payment of charges arising under my/our Municipality of Kincardine Accounts.
This authority is to remain in effect until the Municipality of Kincardine has received written notification from me/us of its change or termination. This notification must be received in writing at least Five (5) business days before the next withdrawal is scheduled.

By submitting this agreement I/we acknowledge that I/we have read, understood and agreed to the Customer Agreement. I/we also acknowledge that the Agreement may be subject to change in the future.

I/we have certain recourse rights if any debit does not comply with this agreement. I/we have the right to reimbursement for any PAP that is not authorized or is inconsistent with this PAP agreement. To obtain further information I/we may contact my financial institution or visit www.payments.ca

I agree to the above statement and authorize this transaction.

I agree.

Personal information is collected under the authority of the Municipal Act, 2001 for the purposes of creating a record to be used for the purpose of setting up Preauthorized Payment Plans for taxes, utilities and accounts receivable. Questions about the collection of personal information may be addressed to the Clerk of the Municipality of Kincardine, 1475 Concession 5, R.R. 5 Kincardine ON N2Z 2X6 Phone: 519-396-3468.

Contact(s)