Pre-Authorized Tax Pre-Payment / Utility Payment Application
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1
2Financial Services Division
1100 Patricia Boulevard, Prince George, BC V2L 3V9
Corporate Services
Telephone: (250) 561-7600
Fax: (250) 561-7724
PRE-AUTHORIZED TAX PRE-PAYMENT / UTILITY PAYMENT APPLICATION
Folio:
_________________________________________
Utility
Acct:
_____________________________________
Property Address:
______________________________________________________________________________
Name:
_______________________________________________________________________________________
Mailing Address:
_______________________________________________________________________________
City:
Province:
Postal Code:
___________________________________
__________
________________________
Home Phone:
____________________
Work Phone:
____________________
Cell phone:
___________________
Please enroll me in the following payment plan(s):
UTILITY PAYMENT PLAN
Start Date:
______________________________________
TAX PRE-PAYMENT PLAN
Start Date:
______________________________________
Taxes: expected home owner grant (please note that this is for calculation purposes only and is subject
to eligibility):
no grant
basic grant
additional grant
These services are for (check one):
Personal
Business Use
I may revoke my authorization at any time, by phone or in writing, subject to providing notice of ten (10) days prior
to the 30th day of the month. To obtain a sample cancellation form, or for more information on my right to cancel
a PAD agreement, I may contact my financial institution or visit
I/we have read and agree to the terms and conditions on this application form, and hereby authorize the City of
Prince George to draw pre-authorized monthly payments from my/our account for the pre-payment of taxes
and/or the payment of utilities on the 30th day of each month (28th day for February).
Signature of Account Holder:
Signature of Joint Account Holder (if applicable):
________________________________________
_______________________________________________
________________________________________
_______________________________________________
name - please print
name - please print
Date:
___________________________________
Date:
__________________________________________
I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to
receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To
obtain more information on my recourse rights, I may contact my financial institution or visit
TAX PRE-PAYMENTS AND UTILITY PAYMENTS ARE NOT REFUNDABLE
ALL PROPERTY TAXES MUST BE PAID PRIOR TO ENROLLING IN THE TAX PRE-PAYMENT PLAN
Attach a void cheque, direct deposit form or counter cheque to this application.
office use only
entered tax _______ ut ______
date stamp
tax ____ pmts of $ __________
ut $ ______________________
edms doc 150399
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Parent category: Financial