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I/We authorize the Town of Slave Lake and the ﬁnancial institution designated (or any other ﬁnancial institution I/we may authorize at any time) to debit the bank account identiﬁed above on the 15th day of each month for the current monthly amount of my utility bill. The actual withdrawal date at my ﬁnancial institution may vary slightly but I will ensure that my account has suﬃcient funds to cover the pre‐authorized withdrawal. In the event that two payments are missed within a calendar year this agreement will be automatically cancelled. The monthly amount will vary during the year up to a maximum of $500.00.
I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any payment that is not authorized or is not consistent with this agreement. To obtain more information on your recourse rights, contact your ﬁnancial institution or visit www.cdnpay.ca.
This authority is to remain in eﬀect until the Town of Slave Lake has received written notiﬁcation from me/us of its change or termination; this notiﬁcation must be received at least ten (10) days before the next debit is scheduled. I/We may obtain a sample cancellation form, or more information on my/our right to cancel this agreement at my/our ﬁnancial institution or by visiting www.cdnpay.ca. Town of Slave Lake pre‐authorized payment cancellation and change of bank forms are available online at www.slavelake.ca or through the contact information below.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
The personal information requested on this form is being collected by Municipal Operation as required by the Town of Slave Lake, under the authority of the Freedom of Information and Protection of Privacy Act (FOIP act) Section 33(c). If you have any questions about the collection or use of your personal information, contact the Town of Slave Lake FOIP Coordinator at (780)849‐8018.
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