Form Builder

Municipal Services

Request to Cancel Payment Plan

I (we) wish to cancel my (our) authorization to issue pre-authorized payments against my (our) account number noted above.  I (we) acknowledge that this cancellation does not terminate my (our) obligation(s) to make payments to the Municipality of Leamington, including those payments previously subject to the now cancelled payment plan.

Where the Account Holder's account agreement requires the signature of two or more signing authorities, the signatures of all such persons are required to cancel this Payment Plan.

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.


© 2020 The Municipality of Leamington 111 Erie Street North, Leamington, Ontario N8H 2Z9

Phone: 519-326-5761
Fax: 519-326-2481
Email: General Information

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