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Pre Authorized Payment Plan 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.
First Name
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Last Name
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Mailing Address
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Mailing Address Line 2
City
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State/Province/Region
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Zip/Postal Code
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Phone Number
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Country
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Email Address
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Address of Property in Pelham (if different then mailing address above)
Choose type of account for automatic withdrawal:
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Water
Tax Plan #1 (4 withdrawals done at instalment due date: last business day of Feb, Apr, Jun & Sep)
Tax Plan #2 (10 withdrawals done from January 15th to October 15th)
Tax Plan #3 (12 withdrawals done from January 15th to December 15th)
Please Enter Your Water Account Number: (if applicable)
Please Enter Your Tax Roll Number: (if applicable)
Effective Date for Withdrawl:
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These services are for:
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Business Use
Personal Use
Financial Institiution Information
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Bank
Address
City
Province
Postal Code
Bank Branch Number
Account Number
Transit Number
Financial Information
Bank
Address
City
Province
Postal Code
Bank Branch Number
Account Number
Transit Number
Please Upload a void cheque: