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Pre-authorized Payment Banking Information Change

Use this form to request to change the bank account information for an existing pre-authorized payment plan.

Changes must be requested by the 30th of the month prior to the next withdrawal date for the Arrears Plan and the Monthly Plan, and 14 days before the next withdrawal date for the Instalment Plan

Roll No.

Effective date to update information (Changes must be requested by the plans deadline prior to the next withdrawal and cannot be a withdrawal date)

Attach a void cheque or an automatic debit form with the new banking information (Must be a chequing account)

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Municipal Address:

Owner Name (s):

Phone number:

Email:

Signature of owner making the request

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Town of Whitby

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Pre-authorized Payment Banking Information Change