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Pre-Authorized Debit Application - Utilities

The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act.  It will be used for the purpose of administering pre authorized debit.  Direct any questions about this collection to:  FOIP Coordinator at the Town of Stony Plain 780-963-2151.

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 deductions as per my/our Town of Stony Plain Utilities account(s).  Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the last day of each month.  The Town of Stony Plain Utilities will provide 10 days written notice of the amount of each regular debit.  The Town of Stony Plain will obtain my/our authorization for any other one-time of sporadic debits.

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.  This notification must be received at least ten (10) business days before the next debit is scheduled.  I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting Payments Canada.

The Town of Stony Plain Utilities 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 notice to me/us.

I/We have certain recourse rights if an debit does not comply with this agreement.  For example, I/we have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement.  To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/we may contact my/our financial institution or visit Payments Canada.

I/We understand that if 2 (two) consecutive payments are not honoured, the privilege of this program will be cancelled.

In the event that the withdrawal fails to be honoured by the financial institution, the utility account will be charged as if an NSF cheque was drawn, and the normal collection process shall be followed.


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