Required fields are marked with asterisks (*)

Pre-Authorized Payment Plan for Tax Payments

Please complete this form if you would like to authorize the Township of Essa to withdraw funds from your bank account to pay for your tax payments. Please note that 10 days notice is required prior to the first withdrawal.

If you do not know your Roll No., please phone the Township office at 705-424-9917 ext. 106.

All mandatory fields are marked with an asterisk(*).

Property Owner's Name

Phone Number

Email Address

Roll No.:

Municipal Address

Please provide a VOID cheque or a Pre-Authorized Debit Form from your financial institution

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Would you like to set up Pre-Authorized Payments for Taxes on more than one property?

Yes

I hereby authorize the Township of Essa to withdraw payments from my bank account to pay my taxes in the following manner:

Please select on of the following options:

Option 1 - equal monthly payments from January to October with the balance in November withdrawn on the last banking day of each month

Option 2 - regular tax installments on the regular due dates

Option 3 - monthly payments to clear my arrears. Payments will be withdrawn the last banking day of each month.

Rules and Conditions of Pre-Authorized Payment Plan

There will be a $40.00 handling charge for any payment request that is refused by your bank due to insufficient funds or a closed account. A second occurrence will automatically cancel your pre-authorized payment arrangements with the Township of Essa. The Township of Essa does not assume responsibility for receipt of inaccurate banking data. Any outstanding amounts will become due immediately.
Should your banking information change at any time, a new Pre-Authorized Payment Form must be completed.
You must provide the Township of Essa with written notification of any change in bank accounts or residence, or the sale of your property. A lawyer's letter is not sufficient.
Supplementary tax bills must still be paid directly to the Township of Essa.
You may revoke/cancel authorization for pre-authorized payments at any time, within ten days prior to the due date, by providing written notice to the Township of Essa.
You have certain recourse rights if any debit does not comply with this Agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the Pre-Authorized Payment Agreement.

Privacy statement

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 purposes for which its collection was intended. If you require additional information, please view our Freedom of Information Policy.

Date of Application

By signing this form, you hereby authorize the Township of Essa to withdraw payments from your bank account to pay property taxes, and you are indicating that you have read and agree to the Rules and Conditions of the Pre-Authorized Payment Plan Agreement

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