Pre-authorized payment registration: Utility account

Signing up for Utility pre-authorized payment plam authorizes the Town of Cochrane to automatically withdraw from your bank account the balance owing on your monthly utility bill on the due date.

Property ownership

Is this for a commercial or residential property?

Commerical

Residential

Are you setting up new or making a change?

New

Making a change

Payor's information

First name

Last name

Utility account number

Service address

Address

City/Town

State/Province

ZIP/Postal Code

Phone number

With email billing, you can expect to receive your Utility bill on or before the 9^th of each month.

Name of financial instituion

Branch number

Institution number

Account number

VOID cheque

A personalized void cheque or a bank stamped pre-authorization debit form must be attached.

Authorization

Pre-authorized debit details

I/We hereby authorize the Town of Cochrane and its Financial Institution to debit my/our account listed above for monthly utility charges (i.e. water, sewer, refuse, recycling) payable to the Town of Cochrane in the amount of the monthly utility invoice amount. Utility Accounts must be paid for in full for eligibility in this plan.
PAD Agreement Category – Personal (Utility Payments)
A copy of the monthly invoice will be emailed or mailed to you and the amount of the invoice will be debited from your account on the due date shown on the monthly invoice.
You, the Payor, authorize the Town of Cochrane to debit the bank account identified above for the amount due as indicated on the monthly invoice. Payments will be processed on the 30th of each month, except in February, when payments will be processed on the 28th or 29th, or the next business day if the 28th or 29th falls on a weekend or holiday. You, the Payor confirm that you have the authority, under the terms of your account agreement, to grant this debit.
Please attach a sample cheque marked “VOID” or Direct Debit Authorization form from your financial institution to this authorization. If this is a savings account, the Branch/Institution/Account numbers have been verified by the financial institution.
Any payments returned as Non-Sufficient Funds (N.S.F.) or because of a closed account may result in termination of the Debit Plan; and all outstanding utilities become due and payable and subject to penalties. A $40.00 service charge will be levied on all returned payments.
You, the Payor, may revoke your authorization at any time upon two (2) weeks’ written notice, and any outstanding utility charges become due and payable and subject to penalties. To obtain a sample cancelation from, or for more information on your right to cancel a PAD agreement contact your financial institution or visit www.payments.ca
In the event of a sale of the above noted property or a change in bank accounts, I/We will notify the Town of Cochrane in writing at least two (2) weeks prior to the next due date to arrange for cancellation or provide the new bank account information and a cheque marked “VOID”.
You, the payor, have certain recourse rights if any debt does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the Utility PAD agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.payments.ca
All individuals whose signatures are required on the above-mentioned bank account have signed this agreement below.

Pre-authorized debit details

I/We hereby authorize the Town of Cochrane and its Financial Institution to debit my/our account listed above for monthly utility charges (i.e. water, sewer, refuse, recycling) payable to the Town of Cochrane in the amount of the monthly utility invoice amount. Utility Accounts must be paid for in full for eligibility in this plan.
PAD Agreement Category – Personal (Utility Payments)
A copy of the monthly invoice will be emailed or mailed to you and the amount of the invoice will be debited from your account on the due date shown on the monthly invoice.
You, the Payor, authorize the Town of Cochrane to debit the bank account identified above for the amount due as indicated on the monthly invoice. Payments will be processed on the 30th of each month, except in February, when payments will be processed on the 28th or 29th, or the next business day if the 28th or 29th falls on a weekend or holiday. You, the Payor confirm that you have the authority, under the terms of your account agreement, to grant this debit.
Please attach a sample cheque marked “VOID” or Direct Debit Authorization form from your financial institution to this authorization. If this is a savings account, the Branch/Institution/Account numbers have been verified by the financial institution.
Any payments returned as Non-Sufficient Funds (N.S.F.) or because of a closed account may result in termination of the Debit Plan; and all outstanding utilities become due and payable and subject to penalties. A $40.00 service charge will be levied on all returned payments.
You, the Payor, may revoke your authorization at any time upon two (2) weeks’ written notice, and any outstanding utility charges become due and payable and subject to penalties. To obtain a sample cancelation from, or for more information on your right to cancel a PAD agreement contact your financial institution or visit www.payments.ca
In the event of a sale of the above noted property or a change in bank accounts, I/We will notify the Town of Cochrane in writing at least two (2) weeks prior to the next due date to arrange for cancellation or provide the new bank account information and a cheque marked “VOID”.
You, the payor, have certain recourse rights if any debt does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the Utility PAD agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.payments.ca
All individuals whose signatures are required on the above-mentioned bank account have signed this agreement below.

Signature of Account Holder

Sign above

Access to Information and Privacy Protection

The personal information collected through this form will be used to process your application. The information relates directly to and is necessary for the operation of the program or activity applied for and will be input into an automated system to generate content or make decisions, recommendations, or predictions. This information is collected and used under the authority of Section 4(c) of the Protection of Privacy Act and managed in accordance with the Act. For questions about the collection of personal information, please contact ATI@cochrane.ca.