Pre-Authorized Payment Application

Pleaes submit this form if you would like to enroll in pre-authorized payments for taxes, utilities and/or general receivables accounts.

For a joint account, all depositors must sign if more than one signature is required on cheques. 

Terms and Conditions

1. Pre-authorized plans are non-transferrable. If you purchase or sell a property or you are a tenant that has moved, you must withdraw from your original plan and complete a new application a minimum of five business days prior to the next scheduled withdrawal.
2. We offer monthly and due date plans for taxes and utilities and due date plans for general receivables. 
3. You will receive a copy of your invoices.
4. Please review your invoices and any statements you may receive as it is your responsibility to ensure your account does not have any amounts owing. If amounts remain owing after withdrawal dates, interest at a rate of 1.25% per month will apply. 
5. Please provide the Municipality with written notification at least five business days prior to the next withdrawal date if you have changed your banking information or wish to terminate this agreement.

Payment Plan Options

• Taxes - Monthly: Payments are withdrawn on the last business day of the month from January to December. You are required to provide the amount you wish to have debited from your account monthly. 
• Taxes - Due date: The full amount of each installment together with any balance on the account will be withdrawn on the installment due date for the tax bills. Balances may include but are not limited to miscellaneous charges being added to the tax account for collection such as utility billing arrears.
• Utility - Monthly: Payments are withdrawn on the first business day of each month. You are required to provide the amount you wish to have debited from your account monthly.
• Utility - Due date: The full amount of each invoice will be withdrawn on the due date shown on the invoice. There are four invoices annually for Lion's Head Water users and two invoices annually for Tobermory Sewer System and Lakewood Subdivision Sewer users.
• General Receivables - Monthly: The full balance on the account will be withdrawn on the first business day of the month. 

Choose applicable plan(s):

I/we authorize the Municipality of Northern Bruce Peninsula and financial institution designated (or any other financial institution I/we may authorize at any time) to begin withdrawals as per my/our instructions for payment of charges arising under my/our municipal accounts. This authority is to remain in effect until the Municipality of Northern Bruce Peninsula has received written notification from me/us of its change or termination. This notification must be received in writing at least five business days prior to the next scheduled withdrawal. 

By submitting this agreement, I/we acknowledge that I/we have read, understood and agreed to the Customer Agreement and further acknowledge that the Agreement may be subject to change from time to time. 

I/we have certain recourse rights if any debit does not comply with this agreement. I/we have the right to reimbursement for any PAP that is not authorized or is inconsistent with this PAP agreement. To obtain further information, I/we may contact my/our financial institution or visit www.payments.ca. 

The personal information on this form is collected under the authority of the Municipal Act and will be used only for the purposes of setting up preauthorized payments. Questions concerning the collection of personal information should be directed to the Municipal Clerk at 56 Lindsay Road 5, Lion's Head, ON  N0H 1W0 or by telephone at (519) 793-3522 ext. 236.