Water & Sewer Billing
Customer Agreement & Authorization 
Pre-Authorized Payments

A debit in the amount stated on the water/sewer bill may be drawn on the
bank account on the due dates as established by municipal by-law.

The undersigned customer authorizes the Town of South Bruce Peninsula to
debit the bank account at the above branch and institution in payment of water/sewer
billing under the terms and conditions agreed to between the undersigned and the
Town of South Bruce Peninsula, until such time as written notice to the contrary is
received by the Town of South Bruce Peninsula. After two missed payments the
customer forfeits the right to continue on this pre-authorized payment plan and the
balance owing must be paid in full.

It is acknowledged by the undersigned that delivery of this Authorization to the Town of South Bruce Peninsula constitutes delivery by the undersigned to the above noted financial institution. It is warranted by the undersigned that the person whose signature is required to sign on the above customer account has signed this authorization.