"*" indicates required fields
A debit in the amount stated on the water and/or sewer bill may be drawn from the bank account on the due dates established by municipal by-law.
The undersigned customer authorizes the Town of South Bruce Peninsula to debit the bank account provided in payment of water and/or sewer billing, under the terms and conditions agreed to between the undersigned and the Town of South Bruce Peninsula.
This authorization will remain in effect until written notice to cancel or change the authorization is received by the Town of South Bruce Peninsula.
After two missed payments, the customer forfeits the right to continue on this pre-authorized payment plan, and the balance owing must be paid in full.
By signing this authorization, the undersigned acknowledges that delivery of this authorization to the Town of South Bruce Peninsula constitutes delivery by the undersigned to the financial institution noted above.
The undersigned warrants that the person whose signature is required for the customer account noted above has signed this authorization.
