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Application for Pre-Authorized Banking Information Change

This application is used to notify the City of Kitchener that I wish to change my financial institution information for pre-authorized payments for property taxes and/or utilities.

Applicant and financial information

Payor

Application form must be submitted by the Payor

Application is for

Personal

Business

Application type (select all that apply)

Property taxes

Utilities

Property (or service) address

Unit

Street number

Street

City

Mailing address

Unit

Street number

Street or PO Box

City

Province / State

Country

Postal code / zip code

Financial institution

Name of institution

Transit number

Institution number

Account number

Please attach a picture of a void cheque or a bank form from your financial institution

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Cheque example showing cheque number, transit number, institution number and account number

Confirm email

Phone number (day)

Confirm phone number (day)

By entering this agreement you certify that you are authorized to enter this agreement with respect to the financial institution account information provided without consent from any other persons or entities. If more than one signature is required on cheques issued against the account, this agreement may not be entered into online and a signed agreement must instead be submitted with all required signatures. The agreement can be downloaded from the City of Kitchener’s website.

By checking this box, I agree that the terms and conditions of the original authorization for Pre-Authorized Debits still apply.

I accept