Pre-authorized Payment Plan Enrollment Form

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 the Municipality of Lakeshore Pre-authorized Payment Plans.

Water Pre-authorization Plan

Your Water Account Format is:

XXXXXXXXX (9 digits) 

Payments are withdrawn according to the amount and due date on your water bill.

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 PAP plans.

Terms and Conditions:

I/We (the above named customer) authorize the Corporation of the Municipality of Lakeshore to debit my/our account for the above noted plan(s). I understand that if a payment for the 15th falls on a weekend this payment will be withdrawn on the Friday before. This authority is to remain in effect until the Municipality of Lakeshore has received written notification from me or until the notice of termination is provided to me.

 I/We (the above named customer) understand that if there is an amount owing on November 1st, afterwhich all taxes for Installment and 10 Month Plans should be paid in full, an additional payment of the outstanding amount shall be withdrawn on the 15th of November, of the last business day before the 15th if it falls on a weekend.