Pre-authorized payment plan change form

This form is for the cancellation of a pre-authorized payment plan or to make a change to the banking information of an existing pre-authorized payment plan. 

Part A - Instructions

Step 1: Complete Parts B to D of the Pre-Authorized Payment Plan Change Form.

Step 2: Attach banking information if applicable.

• An unsigned cheque marked “VOID” or
• A document from your financial institution detailing your bank account information

Step 3: Submit Change Form at least 10 days prior to your invoice due date.

Part B - Account and Contact Information

Part C - Requested Action

Part D - Authorization

I, as the account owner or legal representative, authorize the City of Peterborough to make changes to my PAP Plan as outlined in this form.