Required fields are marked with asterisks (*)

Property Tax - Request for Pre-Authorized Payment Plan Change

2 weeks notice is required before the next scheduled withdrawal of the payment plan

Roll Number

Property Address

Please advise start date: MM/dd/yyyy

I would like to change:

my bank account information. New banking information must be submitted.

from Installment Due Date Payment Plan to 10 Month Payment Plan (Payment Plan 1)

from 10 Month Payment Plan to Installment Due Date Payment Plan (Payment Plan 2)

Provide best contact phone number.

Email Address:

Statement - Online Form Submission:

By submitting this online form to the Municipality, the user acknowledges that the submission is deemed to be a substitute for the user’s signature on the online form and signifies that the user has read, understood and agreed to the terms and conditions of the online form and any document referenced in the online form.

Please confirm that you have read and accept the "Statement - Online Form Submission"

Yes, I have read and accept the "Statement - Online Form Submission".

Date: MM/dd/yyyy

Name of Property Owner

Privacy Statement: Personal information on this form is collected subject to the Municipal Freedom of Information and Protection of Personal Privacy Act R.S.O. 1990, c. M. 56 and may be subject to disclosure to third parties in accordance with the provisions of that Act. The personal information collected on this form will be used for municipal account updates. Questions about the collection of this information may be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, Ontario N8H 2Z9, Telephone 519-326-5761.

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