Required fields are marked with asterisks (*)

Tax Instalment Payment Plan Pre-Authorized Debit Application

Customer Information

Name:

Tax Roll #

Street Address of Property:

Mailing Address (if different than street address):

Telephone Number:

Email Address

Select your preferred withdrawal date:

End of Month

16th of Month

Both

Bank Account Information

Please upload a sample cheque marked "VOID" or a bank document

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

Terms and Conditions

Authorization

Please read and check each statement

This authorization may be cancelled at any time by providing at least 10 business day notice prior to the next withdrawal/due date.

I hereby understand that any returned payments are subject to a $35 service charge. Failure to remit payment and applicable service charges in full prior to the date specified within your notification letter will result my termination from this pre-authorized debit program.

In the event of the sale of the above noted property or a change in bank account, I will notify the Town of Morinville, in writing at least 10 days prior to the next due date, to arrange for cancellation, or to provide the new bank account information.

I understand that taxes owed from January to the enrolment date in this pre-authorized debit plan must be paid in full prior to commencement, including all tax arrears and penalties.

I hereby authorize the Town of Morinville to debit the bank account identified above for all property taxes including any local improvement levies payable to the Town of Morinville, as identified above on the selected withdrawal dates (or the next business day), beginning on the date indicated above.

I understand this authorization is subject to change twice a year to reflect the current annual Property Tax Notice issued by the Town of Morinville.

Applicant (type name):

Date:

Signature:

Clear

The information on this form is collected under Section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP) and is used solely for purposes relating to the Town of Morinville. If you have any questions, please contact the Information Management/FOIP Coordinator for the Town of Morinville at 10125-100 Avenue, Morinville, AB, T8R 1L6 or by calling (780)939-4361.

Forms

Tax Instalment Payment Plan Pre-Authorized Debit Application

Customer Information

Bank Account Information

Terms and Conditions

Authorization