Navigation
Explore left column
Explore content area
Explore footer area
Go
A
A
A
Main Menu
Home
My Home
My Business
About Us
Governance
Reviews & Audits
Codes
Conditions Of Service
Rates
News
EasyBlog
Contact Us
Pre-authorized Payment Agreement
I/We hereby authorize the Town of Tillsonburg to draw amounts from my financial institution for automatic bill payments.
Family or Company Name (In Full):
(*)
Invalid Input
Cycle:
(*)
Invalid Input
Account No:
(*)
Invalid Input
Service Address:
(*)
Invalid Input
Telephone Number:
(*)
Invalid Input
Select Payment Plan Type:
Variable Payment Plan (Actual amount due)
Equal Payment Plan (Residential, SSS customer ONLY)
Invalid Input
I/We authorize the financial institution named below to debit the bank account number named below for all utility payments, payable to the Town of Tillsonburg.
Bank Account No:
(*)
Invalid Input
Transit No:
(*)
Invalid Input
Bank Branch Number
(*)
Invalid Input
I/We will notify the Town of Tillsonburg immediately of any change in bank account or residence. By entering your name/names in the boxes below you are digitally signing this form and agreement.
Full name of applicant:
(*)
Invalid Input
2nd Name of applicant (if applicable):
Invalid Input
Date:
Invalid Input
Tick to confirm:
Invalid Input
My Business
Open a new account
Make changes to your account
Monitor your usage
Billing options
Incentive programs
Conservation
My bill
Streetlight repair
Other maintenance
Preauthorized Payment Agreement
Safety
Call before you dig
Bill Inserts
