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Customer Agreement and Authorization Form

Pre-Authorized Debit (PAD) Plan for City of Owen Sound Water / Waste Water

Type of Property:

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I/We authorize the City of Owen Sound, and the financial institution designated, to begin deductions as per my/our instructions for regular quarterly payments or one time payments from time to time, for payment of all charges arising under my/our City of Owen Sound Utility account(s). The City of Owen Sound will provide written notice of the amount for the debit in advance of the debit date(s). This authorization remains in effect until the City of Owen Sound Water / Waste Water Billing Division has received notification from me/us of its change or termination. This notification must be received at least 10 days prior to the next scheduled debit. I/We have certain recourse rights if any debit does not comply with this agreement. I/We have the right to reimbursement for any PAD that is not authorized or is consistent with this PAD agreement. To obtain further information I/we may contact my/our financial institution or visit

Please indicate you agree with these terms and authorize this pre-authorized debit plan:



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