Pre-Authorized Debits

APPLICATION DEADLINE:

This form must be fully completed and accepted by the County of Grande Prairie No. 1 no later than fifteen (15) days prior to the current utility billing payment due date in order to participate.

If payments are from a chequing account please include one of your personal cheques marked ”VOID” and return with your form and if the account information is drawn on any other account, please attach a printout from your bank of the banking information.

Here’s How Pre‐Authorized Utility Payments Work:

It’s a modern, easy method to pay your bimonthly utility bills. There is no inconvenience of cheque writing; cost of postage; or that trip to pay your bills. With your permission, your payments will be made automatically through your bank or financial institution account, on the current utility billing payment due date (currently 30 days from the billing date). You are still mailed a utility bill every 2 months and your payment amount for the utility services will be stated on each utility bill. You as the owner (s) are the only one(s) who can cancel your utility installment payments and this must be done in writing within fifteen (15) days of the next payment that is due.

Please call (780) 513‐3965 if you have any questions in regards to this application.

Payee: County of Grande Prairie No. 1
10001 84 Avenue, Clairmont AB  T8X 5B2
Phone: 780-532-9722
Financial Institution: TD Canada Trust

Mailing Address

Utility Account Number(s)

Banking Information

Payor(s)

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I/WE (the above named Payor(s)) AUTHORIZE THE PAYEE TO DEBIT MY/OUR ACCOUNT INDICATED ABOVE, IN THE AMOUNT OF MY UTILITY ACCOUNT BALANCE WHICH MAY BE DRAWN ON THE PAYOR’S ACCOUNT ON THE CURRENT BILLING PAYMENT DATE. ALSO NOTING, THE AMOUNT CAN BE INCREASED/DECREASED AS PER CHANGES IN THE UTILITY ACCOUNT BALANCE DUE, AS INDICATED BY THE PAYEE, FOR THE CURRENT AND SUBSEQUENT UTILITY BILLINGS, SO LONG AS THIS AUTHORIZATION HAS NOT BEEN CANCELLED.

I/WE WILL NOTIFY THE PAYEE PROMPTLY IN WRITING IF I/WE MOVE THE ACCOUNT FROM ONE BANK OR BRANCH TO ANOTHER, OR IF THERE IS ANY OTHER CHANGE IN THE ACCOUNT.

I/WE UNDERSTAND THAT THE BANK IS NOT RESPONSIBLE TO VERIFY WHETHER THESE PAYMENTS ARE PROPERLY DEBITED TO MY/OUR ACCOUNT.

What are your rights and responsibilities?

1. Should an incorrect amount be processed against your account, it will be corrected when you have advised the company that you are paying (County of Grande Prairie NO. 1)
   
   
2. The Payee will provide you with written notice of the date of and the amount to be debited to your account on your regular utility billing.  The date of the actual debit will be the current payment due date.
   
   
3. If a payment processed against your account is not in accordance with your authorization, because you cancelled your authorization in writing to the Payee or if prenotification ( as set out in section 2 above) was not received, then you can ask your bank (by completing a “Declaration Form” at the branch where your account was debited) any time up to ninety (90) calendar days (in the case of a Consumer Pre‐Authorization payment), or ten (10) calendar days (in the case of a Business Pre‐Authorized Payment) after your account is debited for the payment, to return the payment to you.  After these time periods, the Bank is not responsible to return the payment, and you must deal directly with the Payee for reimbursement.
   
   
4. The Payor undertakes and agrees to inform the Payee, in writing and within fifteen (15) calendar days prior to the next due date, of any change to the account or address information provided in this authorization.  The Payor acknowledges that if it transfers its account to another financial institution, this authorization becomes null and void on the date of the transfer.  Furthermore, it will be necessary for the Payor to provide a new authorization to the Payee if the payor wishes to authorize the Payee to debit the Payor’s new account.
   
   
5. The Payor acknowledges that, on the day on which a debit is authorized to be presented is not a business day, the amount of the debit may not be debited until the next business day.
   
   
6. The privilege of continuing in the plan, may be cancelled by the Payee if an installment is not honored.  Penalty for non‐payment shall be imposed.
   
   
7. Any bank charges imposed upon the Payee by the Payee’s Financial Institution due to default of payment of any installment by the Payor and any handling charges imposed by the Payee, shall be added to and form part of the Payor’s utility account(s).
   
   
8. The Payor warrants that all persons whose signatures are required to sign on this account have signed their agreement above.
   
   
9. The Payor acknowledges that it will not be possible for the Payor’s Financial Institution to stop payment of a pre‐authorized debit unless the exact amount of the debit is specified in the stop payment request.  The Payor further acknowledges that if a stop payment request of a Pre‐Authorized Debit  issued under an authorization is not honored because the stop payment requested did not specify the exact amount of the debit, it will have no recourse against the Payor’s Financial institution of any loss which the Payor may incur and any dispute concerning the debit is a matter to be resolved between the Payor and the Payee directly.
   
   
10. The Payor acknowledges that it understands and agrees to accept and participate in the Consumer Pre‐Authorized Debit plan in accordance with the Canadian Payments Association rules and policy statements and acknowledges receipt of a copy of this authorization.  

Protection of Privacy - Personal information is collected in accordance with Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act (the FOIP Act) and will be protected under Part 2 of that Act. It will be used for the purposes of administering the program or service for which the information is collected. Should you require further information about collection, use and disclosure of personal information, please contact the FOIP Coordinator at foip@countygp.ab.ca or call 780-532-9722.