Pre-Authorized Tax Payment Plan Form

Please choose one of the following *

NEW Enrollment
Banking Change
Plan Cancellation

Property Owner *

First

Last

Property Owner (Optional)

First

Last

Second property owner.

Roll Number *

Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Phone Number *

Email *

Choose one of the following options *

Option 1: 11 Month Plan (February through December). “$X” on my/our account on the 15th day of each month (or next business day if this day falls on a weekend or holiday) with variable payment amount $X being stated on a statement mailed to me/us 10 days before the date of the initial withdrawal.
Option 2: Tax Instalment Plan. “$X” on my/our account on the date an installment is due, with variable payment amount $X being stated on the tax bill mailed to me/us 21 days before the date of the initial withdrawal.

Start Date *

Township staff will contact you to confirm this start date

Effective Date of Bank Account Change *

Please enter the date you would like the new banking information to be used.

Effective Date of Cancellation *

Please enter the date you would like the plan stopped.

Banking Information *

Drag & Drop Files, Choose Files to Upload

Please upload a copy of a void cheque or a bank letter stating your account information.

Authorization *

I/We authorize my/our bank to debit my/our account each month as indicated above for all payments payable to the Corporation of the Township of Puslinch (“Township”). I/We accept the Pre-Authorized Tax Payment Plan terms and conditions and authorize the Township to begin deductions for payment of my/our tax account. I ensure that the funds will be available each month to cover withdrawal and that insufficient funds will result in finance charges as applicable and possible cancellation of my enrolment in the payment plan. This authority is to remain in effect until cancelled by either myself or the Township by written notification and given a reasonable opportunity to act.

Authorization to Cancel *

I/We authorize the Township to cancel the Pre-Authorized Payment Plan.

Signature of Owner *

Clear Signature

Signature of Owner

Clear Signature

If second owner listed above.

Personal information on this form is collected under the authority of the Municipal Act. The information is used for the purpose of processing this application and administering the Taxation program and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk’s office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk’s office for assistance.