Pre-Authorization Payment Agreement Form
Complete the form, print and mail/fax the form along with a cheque marked VOID to
the address at the bottom.
Type Of Chequing Account (check one):
You have certain recourse rights if any debit does not comply with this agreement.
For example, you have the right to receive reimbursement for any debit that is not
authorized or is not consistent with this PAP Agreement. To obtain more information
on your recourse rights, contact your financial institution or visit www.cdnpay.ca.
I authorize Horizon Utilities Corporation to debit my/our account indicated above
for all payments payable to Horizon Utilities Corporation. Your treatment of each
payment shall be the same as if I/we had personally issued a cheque authorizing
you to pay as indicated and to debit the amount specified to my/our account. This
authorization may be cancelled at any time upon written notice to Horizon Utilities
allowing reasonable time to act upon your request. Any delivery of this authorization
constitutes delivery by me/us.
For verification purposes, please forward or fax this signed form and a cheque
marked "VOID" to:
Horizon Utilities Corporation
55 John St. North, Hamilton, ON L8N 3E4
Fax: 905-522-6228 (Hamilton) or 905-684-2874 (St. Catharines)
For a joint account, all depositors must sign if more than one signature is required
on cheques issued against the account.