Pre-Authorized Debit Application - Taxes

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Pre-Authourized Debit Application

Tax Installment Payment Plan

I/We authorize the Town of Stony Plain, and the financial institution designated (or any other financial institution I/we may authorize at any time) to begin pre-authorized payment deductions in accordance with the Town of Stony Plain’s monthly Tax Installment Payment Plan (TIPP).

I/We understand that payments are adjusted twice a year to ensure current year taxes are paid in full by the end of each tax year. When there are less than 12 periods remaining in the first year of enrollment, all periods passed must be paid prior to enrolling in this plan unless authorized by the Manager of Finance. Regular monthly payments will be debited from my/our specified account on the 5^th or 17^th of each month. The Town of Stony Plain will obtain my/our authorization for any other one-time or sporadic debits. The Town of Stony Plain may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us.

This authority is to remain in effect until the Town of Stony Plain has received written notification from me/us of its change or termination at least ten (10) days before the next debit is scheduled. I/We understand that once the pre-authorized monthly Tax Installment Payment Plan has been terminated, all unpaid taxes become due and payable and are subject to penalty in accordance with the Tax Penalty Bylaw.

I/We understand that if my/our pre-authorized payment fails to be honored by the financial institution and is returned, the tax account will be charged an NSF fee as per our Fees & Charges Bylaw. Failure to pay dishonored payments within 15 days of the return will terminate my/our eligibility for the pre-authorized Tax Installment Payment Plan. I/We understand that if two (2) consecutive payments are not honored, the privilege of this program will be cancelled regardless as to whether the payments have been made up.

I/We have certain recourse rights if any debit does not comply with this agreement. To obtain more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.payments.ca.

Property Address:

Roll Number:

Name(s) of Applicant:

Business Name (if applicable):

Phone Number:

Email address:

I/We authorize the Town of Stony Plain to automatically debit pre-authorized tax payments from my/our bank account on the 5th or 17th of each month (check one).

5th

17th

For Office Use Only

Year

Signature of Bank Account Holder (use your mouse or touchscreen in the signature box):

Clear

Today's Date:

You MUST include either a copy of a VOID cheque OR a pre-authorized debit form from your bank in order for your request to be processed. Please attach here.

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This personal information is being collected for the Town of Stony Plain under the authority of Section 33c of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to collect information regarding Business License Application. The personal information provided will be protected in accordance with Part 2 of the Act. If you have any questions regarding the collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780-963-2151.