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Customer Pre-Authorized Debit (PAD) Agreement

First Name

Owner or Tenant Information

Last Name

Mailing Address:

City /Town

Province

Postal Code:

Phone number

Email address

E-Billing

Would you like to receive your water/sewer and/or tax bill to the email provided above?

Yes, taxes and water/sewer.

Yes, taxes only.

Yes, water/sewer only.

No thank you.

Service Address in Saugeen Shores:

Payment Plan Options

Which services would you like to register for pre-authorized debit?

Water and Sewer

Property Tax

Financial Information

Please see the example image below for where to find your financial information on your cheque.

Financial Institution Name:

Financial Institution Number:

Transit Number:

Account Number:

By submitting this form to the Municipality of Saugeen Shores, I/we authorize the Town of Saugeen Shores to debit the bank account at the above noted financial institution for the payments indicated above.

Authorized Signature

Additional questions or comments:

This Pre-Authorized Debit (PAD) Agreement may be revoked at any time subject to providing notice at least 10 business days before the next debit is scheduled. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit www.cdnpay.ca.