Sign up/Change for Utilties Pre-Authorized Payment (Current Account Holders Only)

Is this for a commercial or residential property?

commerical

residential

Are you setting up new or making a change?

new

change

First

Last

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.

Account number

Name of financial instituion

You need to fill out a pre-authorized payment agreement to provide permission for the withdrawals for Cochrane utilities invoice payments.

Address

City/Town

State/Province

ZIP/Postal Code

Country

Financial institution branch phone number

Branch number

Institution number

Account number

Account type

chequing

savings

VOID cheque

Please attach a scan or photo of your VOID cheque.

One file only.
128 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Authorization

I, being the owner of the property identified here, certify that all the information on this application is true. I realize that failure to comply with the regulations and conditions set out in the Town of Cochrane Water Utility Bylaw can and will result in enforcement action against me.

FOIP Statement

The personal information on this form is being collected under the authority of section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act and Part 10, section 340(1) of the Municipal Government Act. Your personal information may be used by the Town of Cochrane for the purpose the information was collected or compiled or for a use consistent with that purpose. Your personal and financial information will be managed in accordance with FOIP. If you have any questions about the collection, use, or disclosure of your personal information, please contact FOIP@cochrane.ca.