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Pre-authorized Debit (PAD) Plan Cancellation Request Form

You may withdraw from your Pre-Authorized Debit Plan at any time by providing notice to the City of Richmond Hill (Revenue Services). Notice must be received at least 10 business days prior to the next scheduled withdrawal. For more information on your right to cancel a PAD Agreement, visit www.payments.ca, or contact your financial institution.

Which PAD plan would you like to cancel?

Tax

Water

Both

Customer Information

Service Address:

Owner's Name

Telephone Number

Email Address

If two signatures are required for a chequing account, two signatures must appear on this form.

Does your bank account require two signatures?

Yes

Authorized Signature

Date:

Information Collection Notice

The personal information on this form is collected under the authority of the Municipal Act 2001, S.O. 2001, c. 25. The information will be used for the purposes of responding to and processing your requests for a Pre-Authorized Cancellation request. Questions about this collection can be directed to the Client Relations Analyst, Revenue Services, 225 East Beaver Creek Road, Richmond Hill, Ontario L4B 3P4, by telephone at 905-771-8949 or by email to revenue@richmondhill.ca.

Please view Richmond Hill's Privacy Statement for more information.

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Pre-authorized Debit (PAD) Plan Cancellation Request Form

Customer Information

Information Collection Notice

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