Pre-Authorized Payment Plan Enrollment Form Pre-Authorized Payment Plan Enrollment Form Customer InformationPre-Authorized Payment Program(Required) Personal Business Roll Number (0706-000- ### - ##### -0000)(Required)Owner InformationOwner(s)(Required) First Last Owner(s) First Last Property Address(Required) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Mailing Address(Required) Street Address P.O. Box City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone Number(Required)Email Address(Required) Pre-Authorized Payment DetailsPre-Authorized Payment Option(Required) Due Date Option Monthly Payment Option If you are selecting the DUE DATE OPTION, please your name below and check this box, authorizing the Township of Augusta to debit my bank account on the due date for the amount of my interim and final Property taxes. This is a continual agreement until the Township is notified in writing canceling this agreement. (See below.) First Last Consent to enroll in the DUE DATE optionIf you are selecting the MONTHLY PAYMENT OPTION, please your name below and check the box below, authorizing the Township of Augusta to debit my bank account on the 15th of each month. This is a continual agreement until the Township is notified in writing canceling this agreement. (See below.) First Last Consent to enroll in the MONTHLY PAYMENT optionPAD Applicants will be notified in writing at least 30 days prior with their PAD monthly or PAD due date amount.TERMS AND CONDITIONSChange of Bank Account Information or Increasing / Decreasing Amount of PaymentIf there is a change of Banking information such as a new account and/or closed account, or you wish to increase the amount we are debiting your bank account, please provide us in writing at least fifteen (15) Business days prior to the next scheduled debit.Non-Sufficient Funds / Returned PaymentsIf your Pre-Authorized Payment is returned due to insufficient funds (NSF), a returned fee will be applied to your account. Also under the Canadian Payment Association regulations, two (2) NSF automatic debits will result in Cancellation of the program.Cancellation TermsThis authorization may be cancelled upon notice by the registered owner(s) in writing to the Township of Augusta at least fifteen (15) business days prior to the next scheduled debit. To obtain a sample cancellation form, or for more information on your right to cancel a PAP Agreement, contact your financial institution or visit www.payments.ca.Recourse StatementYou 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, contact your financial institution or visit, www.payments.ca.Terms and Conditions Agreement(Required) I have read and agree to the terms and conditions listed aboveTerms and Consent for Uploading a Void Cheque(Required) I agree to the terms and conditions above and confirm the file is a VOID cheque.To complete your Pre-Authorized Payment Enrollment, please upload a VOID cheque using the secure file upload system below. By submitting this document, you confirm that: - The uploaded file is a VOID cheque from the bank account to be used for payments. - You are the authorized account holder or have the account holder’s permission to use the provided banking information. - You understand that this information will be used solely for the purpose of setting up pre-authorized payments with the Township of Augusta. Note: We cannot accept direct deposit forms, screenshots, or other documents in place of a VOID cheque. Submissions must clearly show the banking institution's name, your account number, and transit number.Upload Your Void Cheque(Required)Max. file size: 300 MB. Date(Required) MM slash DD slash YYYY Signature(Required)Date MM slash DD slash YYYY Name First Last CAPTCHA
