ATRC - Payment Agreement - Municipality of Lakeshore

Required fields are marked with asterisks (*)

Atlas Tube Recreation Centre - Payment Agreement

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used for the purpose of administering payment to the Municipality of Lakeshore.

First and Last Name

Organization Name

Mailing Address

City/Town

Province

Postal Code

Telephone Number

Email Address

What Activity are you paying for?

Payment Information:

Please attach a VOID Cheque or Banking Information to this agreement.

Note: We are unable to accept line of credit bank accounts for payments.

Upload Banking Information (picture or scan cheque / account information

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Terms and Conditions:

I /We (the above named customer) authorize the Municipality of Lakeshore to debit my/our account for the above noted payment and activity. This authority is to remain in effect until the Municipality of Lakeshore has recieved written notification provided by the above named customer or until the notice of termination is provided by the municipality.

I confirm I have read and agree with the Terms and Conditions

Yes