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Roll number

Effective month

Pre-authorized payment plan change form

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

Part A - Instructions

Step 1: Complete Parts B to E of the 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 by the 21^st day of the month in which the change is required.

Part B - Property Information and Owner Contact

Property address

Name

Telephone number

Email address

Part C - Requested Action

Please select an action

Cancellation

Change of Bank Account

Change of PAP Plan Type

Part D - Notes

Notes (i.e. closing date)

Part E - Authorization

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

Signature

Clear

Date of signature