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2. Property Address:*
4. Name on Account (Bank Account Holder)
5. Phone Number
7. Name on Account (Bank Account Holder)
8. Phone Number*
10. Final Payment Date
    Final Payment Date
11. Cancellation Reason:

    1. Sold Property
    2. Other
13. Account to be Canceled*

    1. Utility Account
    2. Tax Account
    3. Utility and Tax Account
15. Electronic Signature Agreement*

    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.

    1. I agree.
17. Electronic Signature*
19. 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 780-849-8000.
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit Submit and Print

* indicates a required field