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Please complete this form if you would like to authorize the Township of Essa to debit your bank account for your quarterly Water & Sewer Invoice.
You are required to provide your Utility Account No., and upload a VOID cheque with this application. If you don't know your utility account number, please contact the Public Works Department at 705-424-9917 extension 114 or 127.
Mandatory fields are marked with an asterisk(*).
Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif
Personal information contained in this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), and will be used only for the purpose for which its collection was intended. Questions about this collection should be directed to the FOI Coordinator at the Township of Essa.
I hereby authorize the Township of Essa to withdraw quarterly payments from my bank account to pay my quarterly Water & Sewer Invoice