Freedom of Information and Protection of Privacy Act. The personal information on this form is being collected pursuant to 26(c) of the Freedom of Information and Protection of Privacy Act for the purposes of billing water customers in accordance with this contract and water system account management. For further information about this collection, you can contact the Privacy Officer at 250.352.8168, xxxxxxxxx@xxxx.xx.xx, or RDCK Privacy Officer, Box 000, 000 Xxxxxxxx Xxxxx, Xxxxxx, XX X0X 5R4. Account Holder Name: Requested Pre-Authorized Payment Plan Start Date: July 15, 2021 January 15, 2022 Account Number: (from water bill) Account Holder Email Address: Account Holder Telephone Number: I agree to the terms of this Water Pre-Authorized Payment Plan Customer Agreement. Account Holder Signature: Date: Please enclose a VOID CHEQUE or provide the following bank account information. The Water Account Holder must have signing authority on the bank account provided. Institution Number Transit Number Account Number RETURN FORM TO EITHER:
Appears in 1 contract
Samples: www.rdck.ca
Freedom of Information and Protection of Privacy Act. The personal information on this form is being collected pursuant to 26(c) of the Freedom of Information and Protection of Privacy Act for the purposes of billing water customers in accordance with this contract and water system account management. For further information about this collection, you can contact the Privacy Officer at 250.352.8168, xxxxxxxxx@xxxx.xx.xx, or RDCK Privacy Officer, Box 000, 000 Xxxxxxxx Xxxxx, Xxxxxx, XX X0X 5R4. Account Holder Name: Requested Pre-Authorized Payment Plan Start Date: □ July 15, 2021 2023 □ January 15, 2022 2024 Account Number: (from water bill) Account Service Civic Address Account Holder Email Address: Account Holder Telephone Phone Number: I agree to the terms of this Water Pre-Authorized Payment Plan Customer Agreement. Account Holder Signature: Date: Please enclose a VOID CHEQUE or provide the following bank account information. The Water Account Holder must have signing authority on the bank account provided. Institution Number Transit Number Account Number RETURN FORM TO EITHER:
Appears in 1 contract
Samples: Customer Agreement
Freedom of Information and Protection of Privacy Act. The personal information on this form is being collected pursuant to 26(c) of the Freedom of Information and Protection of Privacy Act for the purposes of billing water customers in accordance with this contract and water system account management. For further information about this collection, you can contact the Privacy Officer at 250.352.8168, xxxxxxxxx@xxxx.xx.xx, or RDCK Privacy Officer, Box 000, 000 Xxxxxxxx Xxxxx, Xxxxxx, XX X0X 5R4. Account Holder Name: Requested Pre-Authorized Payment Plan Start Date: □ July 15, 2021 2020 □ January 15, 2022 2021 Account Number: (from water bill) Account Holder Email Address: Account Holder Telephone Number: I agree to the terms of this Water Pre-Authorized Payment Plan Customer Agreement. Account Holder Signature: Date: Please enclose a VOID CHEQUE or provide the following bank account information. The Water Account Holder must have signing authority on the bank account provided. Institution Number Transit Number Account Number RETURN FORM TO EITHER:
Appears in 1 contract
Samples: www.rdck.ca
Freedom of Information and Protection of Privacy Act. The personal information on this form is being collected pursuant to 26(c) of the Freedom of Information and Protection of Privacy Act for the purposes of billing water customers in accordance with this contract and water system account management. For further information about this collection, you can contact the Privacy Officer at 250.352.8168, xxxxxxxxx@xxxx.xx.xx, or RDCK Privacy Officer, Box 000, 000 Xxxxxxxx Xxxxx, Xxxxxx, XX X0X 5R40X0. Account Holder Name: Requested Pre-Authorized Payment Plan Start Date: □ July 15, 2021 2023 □ January 15, 2022 2024 Account Number: (from water bill) Account Service Civic Address Account Holder Email Address: Account Holder Telephone Phone Number: I agree to the terms of this Water Pre-Authorized Payment Plan Customer Agreement. Account Holder Signature: Date: Please enclose a VOID CHEQUE or provide the following bank account information. The Water Account Holder must have signing authority on the bank account provided. Institution Number Transit Number Account Number RETURN FORM TO EITHER:
Appears in 1 contract
Samples: Customer Agreement