Pre-Authorized Payment Plan (Pap)
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2MUNICIPALITY OF LEAMINGTON
MUNICIPAL USE ONLY
Roll Number
111 Erie St. N., Leamington, ON N8H 2Z9
Tel: (519) 326-5761 Fax: (519) 326-2481
Attention: Property Tax Division
Account Number
Pre-Authorized Payment Plan (PAP)
Property Tax - Consumer Authorization
ACCOUNT HOLDER INFORMATION
Owner 1
Owner 2 (if applicable)
Property Address
Mailing Address (if different than Property address)
City/Town
Postal Code
City/Town
Postal Code
Home Phone Number
Business/ Cell Phone Number
FINANCIAL INSTITUTION
Name of Financial Institution
Address (Street Name & Number)
City/Town
Postal Code
ACCOUNT INFORMATION
VOID CHEQUE IS ATTACHED IN ORDER FOR MY (OUR) BANKING INFORMATION TO BE VERIFIED
PAYMENT PLAN TYPE
PAYMENT PLAN 1 (10 MONTH PLAN)
A debit, in paper, electronic or other form in the amount of $____________ may be drawn on my (our) account on the first Friday of each
month, beginning in January and continuing until May based on the Interim Tax Levy and five equal payments from June until October
adjusted based on the Final Tax Levy. Interim Tax Notices are not issued for properties on Payment Plan 1.
PAYMENT PLAN 2 (DUE DATE PLAN)
A debit, in paper, electronic or other form, in the amount of the tax instalment due on the particular due date, as indicated on the tax bill
provided to me (us) by the Corporation of the Municipality of Leamington, may be drawn on my (our) account on the appropriate instalment
due date.
I (we) as the account holder (s), authorize the Municipality of Leamington and the above noted financial institution to debit my (our) account,
at the above indicated branch of the financial institution, under terms and conditions agreed to me (us) with the Municipality of Leamington
until such a time as written notice to the contrary is given by me (us) to the Municipality of Leamington.
The branch of the financial institution at which I (we) maintain the account is not required to verify that the payment is drawn in accordance
with this authorization.
I (we) will notify the Municipality of Leamington in writing of any changes in the account information or termination of this authorization prior to
the next due date of the pre-authorized debit. If the debit is returned for any reason, I (we) understand that the PAP privilege will be
rescinded, normal installment payments will commence and any applicable penalties and NSF fees will be charged.
Items charged will be reimbursed subject to notification by me (us) to the branch of the account within 90 days under any of the following
conditions:
a)
I (we) never provided authorization to the Corporation of the Municipality of Leamington.
b)
The pre-authorized debit was not drawn in accordance with this authorization.
c)
My (our) authorization was revoked.
d)
The debit was posted to the wrong account due to invalid/incorrect account information supplied by the Municipality of Leamington.
MUNICIPAL USE ONLY
________________________________________
_______________________
Signature of Account Holder (1)
Date
PAP entered
___________________________________________
__________________________
Date
Signature of Account Holder (2)
Date
*If more than one signature is required on cheques issued
against the account, all depositors must sign.
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