Your Account Number. Property(ies) information: The following properties are a part of this agreement:* Roll No Owner’s name Last Year’s Taxes Projected Taxes 123456.000 Xxx Xxxxx $1,234.56 $1,500.00 Total to be paid under this PAD agreement: *Use another sheet if you need more space. Total taxes due: Administration Fee: $25 Total amount to be financed: Number of payments: Payment Amount: Fixed $ OR Variable $ (max amount) Combination of Fixed of $ and one Variable payment on the last working day of October to pay the balance of the account(s). Dates of Payment: Weekly beginning Friday the Bi-Weekly beginning Friday the Monthly beginning Friday the Annually beginning on the last working day of October This PAD Agreement may be cancelled by either party at any time, subject to providing notification of at least five (5) working days. Please contact the Chief Financial Officer of the Rossburn Municipality to cancel this agreement. You have certain recourse rights e.g., reimbursement if any withdrawal does not comply with this agreement. Please contact the Chief Financial Officer of the Rossburn Municipality if you have any questions about a specific withdrawal. Your financial institution or xxxxxxxx.xx can provide more information about cancellation or your recourse rights. I/We (include all required signatures) authorize the Rossburn Municipality to begin automated withdrawals for payment of my tax bill(s) from the Financial Institution identified on my VOID cheque or in the above Financial Institution information. Authorized Signature no. 1 Authorized Signature no. 2 Name - Signed Name - Signed Name – Printed Name – Printed Date Date PAD Agreement received by on Signature PAD Agreement cancelled by on
Your Account Number. This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination, in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it. Print Name (1) SS#
Your Account Number. □□□□□□□□□□□□□ TRANSIT ABA Checking Savings DEPOSIT AMOUNT: Net Check (* A voided check must be attached to this form for a checking account.) I hereby authorize the City of Marlborough to deposit my payroll check to the financial institution, account and amount I have listed below. I understand that the City of Marlborough may cause my account to be adjusted to the extent necessary to correct any over-deposit, and I agree to hold the below-listed financial institution harmless of any erroneous deposits or adjustments not caused by the financial institution. It is understood that this agreement may be terminated by me at any time by written notification to the City of Marlborough. Any such notification to the City of Marlborough shall be effective only with respect to entries initiated by the City of Marlborough after receipt of such notification and a reasonable opportunity to act on it. Any such notification to the receiving Bank by the employee is unacceptable. Any receiving Bank may terminate this agreement by written notice to me for just cause. Name: (Signature, please)
Your Account Number. 4. Number of shares held in this account: -------------------------
Your Account Number. You agree not to impersonate any person or use a name that you are not authorized to use. You warrant and represent that you are the person intended by the Transferor and entitled to receive the Funds; that you are not a person whose Accounts are blocked under regulations of the Office of Foreign Asset Control (OFAC) of the United States Treasury Department; and that the Information you will provide is true, correct and complete. We reserve the right to decline to complete any transfer, even after you have agreed to all of the Terms, if we have reason to believe that completing the transfer would result in a violation of law or expose us to liability or risk of loss. If the transfer is rejected for any reason, the funds will be returned to the Transferor.
