2. 

3. Utilities 
   Pre-Authorized
   Payment Plan (UPP) 
   Cancel / Change
   Authorization

5. The Utilities Preauthorized Payment Plan (UPP) Cancel / Change form is to be used by account holders to cancel or change their participation in the UPP program.

7. Cancel or Change*

   Would you like to Cancel or Change your UPP Authorization?

   1. Cancel
   2. Change
9. Effective Date*
   Effective Date

   The deadline for UPP termination is 15 days prior to the next payment date, in order to terminate the program beginning with that upcoming payment.

10. Utilities Account or Tax Roll Number
12. Reason for Cancellation*

    Please tell us why you are terminating your participation in the UPP program.

    1. Sold the property (you may re-enroll if moving to a new property in Diamond Valley)
    2. Choosing to pay manually
    3. Someone else is going to pay the tax bills
    4. Other
14. If other, please describe reason*
16. Reason for Change*

    1. Moved / new address
    2. Changed bank account information
    3. Changed name / contact information
    4. Someone else is going to pay the taxes
    5. Other
18. If other, please describe reason*
20. ACCOUNT HOLDER INFORMATION
22. FIRST Name*
23. LAST Name*
25. Owner or Renter?

    1. Owner
    2. Renter
27. If renting, name of registered property owner(s)

    If more than one owner, please separate names using commas.

29. Residential (Physical / Civic) Address*
31. Mailing Address*
33. City / Town*
34. Province*
35. Postal Code*
37. Phone Number*
38. Email Address*
40. NEW BANK ACCOUNT INFORMATION
    
    Name(s) on the Bank Account*

    Include ALL names registered on the bank account.

    Please verify that your information is correct before submitting it.

    

    
    

42. Financial Institution Name*
43. Financial Institution Address*
45. Institution / Bank #*

    3 Digits

46. Branch / Transit #*

    5 Digits

47. Account #*

    Up to 12 Digits

49. Are you interested in receiving your tax and utility account correspondence (bills etc.) via email through our eServices program?*

    1. Yes
    2. No

    Sign up for eServices today

51. ACKNOWLEDGEMENT & AGREEMENT
53. Acknowledgment*

    I instruct the Town of Diamond Valley to cancel or change the UPP payments on my account in accordance with the instructions given on this form. 

    If cancelling, I understand that it is my responsibility to re-enroll in UPP should I wish to participate again.

    1. I agree to the CANCELLATION of my UPP payments
    2. I agree to the CHANGE of my UPP information
55. Choose an Option:*

    1. I am the property owner on file for this utility account
    2. I am a renter / tenant of the property
    3. I am a lawyer or authorized representative for the account holder
57. Agreement*

     I acknowledge that, by typing my name below, I agree to the content of this form  as if I had endorsed this document with my own handwritten signature.  I further agree that all of the information on this termination form is true, accurate and complete to the best of my knowledge.

59. Acknowledgement of additional account holders

    For joint accounts where more than one signature is required on cheques, all required signatures must be provided. I acknowledge by typing the name above that any additional bank account holders have agreed to the Terms and Conditions of the UPP authorization above, and that such entry is endorsed as if with their handwritten signature.

61. Information Collection

    The personal information collected through the Utilities Pre-Authorized Payment (UPP) Cancel/Change Authorization is for the cancellation of the Town of Diamond Valley's UPP. This collection is authorized under section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, contact the Privacy Office LegislativeServices@DiamondValley.town or 403-933-4348

Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field