PLEASE PRINT DATE. Name(s): Policy Number: Type of Service: Personal Business Address: City/Town: Province: Postal Code: Phone Number: Business Residential Credit Card Type: OR Financial Institution (FI): VISA Credit Card Account Number: MasterCard Expiry Date: Branch Address: City/Town: Province: Postal Code: *FI Number: *FI Transit Number: *FI Account Number: 3 digits 5 digits *or void cheque is attached Authorized Signature(s): Submit Guardian Risk Managers Ltd. Tel: 0-000-000-0000 Fax: 0-000-000-0000 Attention: Accounts Receivable E-mail: Xxxxxxxxxx@Xxxxxxxxxxxx.xxx
PLEASE PRINT DATE. PAP Category: BUSINESS Benecaid Group Number (for existing clients): Company Name: Company Street Address: Unit #: City: Province: Postal Code: Phone Number: Designated Financial Institution: FI Code: Transit: Account: (3 digits) (5 digits) Name of Signing Officer(s): Authorized Signature(s): PLEASE ATTACH A VOID CHEQUE Benecaid Health Benefits Solutions Inc. Attn: Finance Department 000 Xxx Xxxx Xxxx, Xxxxx 00 Xxxxxxx, XX X0X 0X0
PLEASE PRINT DATE. Name(s): Unit / Suite / Parking Card #: Type of Service: Personal _ Business Address: City/Town: Province: Postal Code: Phone Number: (Bus.) (Res.) Financial Institution (Bank): Bank Account Number: Transit Number: - (branch – 5 digits; FI – 3 digits) Address: City/Town: Province: Postal Code: Authorized Signature(s): Date: BlueStone Properties Inc. 000 Xxxxxxxx Xxxxxx, Xxxxx 000 Xxxxxx, Xxxxxxx X0X 0X0 Tel: 000-000-0000 Fax: 000-000-0000
PLEASE PRINT DATE. Name(s): MD Utility Account Number: Type of Service: Personal Business Address: City/Town: Province: Postal Code: Phone Number (Bus.) (Res.): Financial Institution (FI): FI Transit Number (3 digits): FI Branch Number (5 digits): FI Account Number: Address: City/Town: Province: Postal Code: SIGNATURE(S) REQUIRED: Authorized Signature: Authorized Signature: Freedom of Information and Protection of Privacy Statement The information is collected in accordance with the Municipal Government Act, Freedom of Information and Protection of Privacy Act, and any other act stated in the Purpose section of this form. Should you have any questions regarding the collection of personal information in this form please contact the municipal office and request to speak with the FOIP Coordinator.
PLEASE PRINT DATE. Name(s): Erie Thames Powerlines Corporation Account Number: Type of Service: Personal □ Business □ Address: City/Town: Province: Postal Code: Phone #: (Bus.) (Res.) Financial Institution (FI): FI Account Number: FI Transit Number: (branch – 5 digits; FI – 3 digits) Address: City/Town: Province: Postal Code: Authorized Signature(s): Erie Thames Powerlines Corporation Attention: Customer Solutions P.O. Box 157 Ingersoll, ON N5C 3K5 Tel: 000-000-0000 or 0-000-000-0000 Fax: 000-000-0000 Email: xxxx@xxxxxxxxxxxxxxx.xxx
PLEASE PRINT DATE. Name(s): City of Lloydminster Utility Account Number: email: Type of Service: Personal Business Address: City/Town: Province: Postal Code: Phone Number: (Res.) (Bus.) Financial Institution (FI): FI Account Number: FI Transit Number: Address: City/Town: Province: Postal Code: Authorized Signature(s): City of Lloydminster Attention: Water Department 0000 – 00 Xxxxxx Xxxxxxxxxxxx, XX X0X 0X0 Phone: (780) 875 – 6184 This form is also available on our website at xxx.xxxxxxxxxxxx.xx Online Banking Available Online banking is available through most financial institutions. This is a convenient way to pay your water xxxx on a timely basis. 3 Easy steps to pay your water xxxx online: • Go to your online banking and add City of Lloydminster as a ‘payee’. It could be under ‘Lloydminster - Water’ or Lloydminster - Utilities’, depending on how the individual bank has it in their system. • Enter your water account number (on the top of your water xxxx) • Make your payment. Credit Card Payments Utility accounts can be paid by credit card by either: • Phone in payment to our cashier at 780.875.6184 extension 2129; or • Set your Utility account up for eBilling to receive your xxxx electronically. Call the Water Department at 780.875.6184 extension 2125 to receive a PIN number that you will require to register online. You will also require your water account number. You can then register at xxxxx://xxx.xxxxxxxxx.xxx/eBill/eBill.asp?c=4315. You may then proceed to pay online with your credit card. Cheques/Cash/Debit Payments Payments can be made by cheque. Mail to: City of Xxxxxxxxxxxx, 0000-00 Xxxxxx, Xxxxxxxxxxxx XX X0X 0X0 Payments can be made in person by cash, credit or debit card. City Hall is open Monday – Friday from 8:00am to 5:00 pm
