Required fields are marked with asterisks (*)

Preauthorized Payment Plan Change Form

Please fill out this form if you would like to update the amount or cancel your preauthorized payment plan, or update your bank account information. If you are setting up preauthorized payments for the first time, please submit the Preauthorized Payments Form to the Treasury Department with a void cheque or fill out the online form.

Account Holder First Name:

Account Holder Last Name:

Service Address:

Street Address:

City:

Province:

Postal Code:

Email:

Phone Number:

Change to Preauthorized Payment Plan:

Change Plan Type

Change Bank Account Information

Update Amount

Cancel

Effective Date:

I am a:

Property Owner

Tenant

Authorized Individual

Executor/Trustee/POA

I would like to update my preauthorized payment plan as per the effective date above. I acknowledge I must give at least 5 business days in order for the change to take effect.

I agree.

Notes:

Personal information is collected under the authority of the Municipal Act, 2001 for the purposes of updating or cancelling 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, Kincardine, ON N2Z 2X6 Phone: 519-396-3468.