Pre-Authorized Debit Cancellation Notice Form   
  The Corporation of the Town of Pelham
20 Pelham Town Square. Fonthill, ON L0S 1E0 Tel. (905) 892-2607 Fax (905) 892-5055

Please use this form to update your information, thus ensuring our records are accurate. 
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I/We acknowledge that this cancellation does not terminate any other obligation that I/we may have with the Payee. *