Cancel pre-Authorized Payment Plan - The Town of Arnprior

Required fields are marked with asterisks (*)

Pre-authorized Payment Cancellation Form

Cancellation requests must be received in our office 14 days prior to the next withdrawal in order to cancel your next payment.

Property roll number

Name:

Property Street Address:

Town

Province

Postal Code

Phone Number

Reason for Cancellation

Cancellation effective date

Signature of Account Holder

Clear

Date

Signature of Joint Account Holder

Clear

Date

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O c.M.56 as amended and will be used to document delegates names, addresses, for pre-authorized payments. Inquiries may be directed to the Town Clerk by telephone at 613-623-4231 ext. 1817 or by email at clerk@arnprior.ca.