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2. UAPP is a plan that enables you to pay your bill from County of Wetaskiwin No. 10 for water, sewer, and waste collection through an electronic transfer from your bank account. Bi-monthly (as per the schedule below), your account will be debited. You will be charged the actual utility charges for 2 months. 

4. PLEASE NOTE: ANY ADDITIONAL CHARGES ACCUMULATED AT THE TIME OF INVOICING (IE. TRANSFER STATION CHARGES) WILL ALSO BE DEBITED FROM YOUR ACCOUNT.
6. Utility Account #:*
8. Last Name:*
9. First Name:*
11. Mailing Address:
13. City:
14. Province:
15. Postal Code:
17. Phone Number:*
18. Email:
20. Legal Land Description (include Plan, Block & Lot if applicable):
22. Quarter:
23. Section:
24. Township:
25. Range:
27. West of the ____ Meridian
28. Plan:
29. Block:
30. Lot:
32. Financial Institution Information
34. Name of Financial Institution: *
35. Branch Phone Number:
37. Branch Address: *
39. Transit Number: *
40. Institution (Bank) Number: *
41. Account Number:*
43. Sample Cheque
    
44. Upload a VOID Cheque or Direct Deposit Form*

    Fill in the transit, institution and account number above or upload a VOID cheque. 

46. 1. I hereby authorize County of Wetaskiwin No. 10 and its Financial Institution to debit my account listed above:
       • for bi-monthly utility charges (i.e. water, sewer, refuse) payable to County of Wetaskiwin No. 10  
       • in the amount of the monthly utility invoice as per the due date noted on the invoice 
    2. Utility accounts must be paid in full for eligibility in the plan.
    3. A specimen cheque marked “VOID” or verification letter from my/our financial institution is attached to this authorization. If a savings account, the Branch / Institution / Account numbers have been verified with my/our financial institution. 
    4. All payments returned NSF will be subject to a fee as per the “Fees and Charges Bylaw”. Regular collection shall apply to any returned payment. Once NSF payment occurs, this contract may become NULL and VOID and the customer will return to standard method of billing.
    5. Should my banking information change, I will notify in writing utility@county10.ca at the County of Wetaskiwin No. 10 at least 15 days prior to the next due date to allow for processing (see UAPP schedule below).
    6. UAPP Cancellation: To discontinue participation in the UAPP program (sale of property, moving, terminating services, or other such reasons), I will notify in writing utility@county10.ca at the County of Wetaskiwin No. 10 at least 15 days prior to the next due date (see UAPP schedule below).

    The treatment of each payment shall be the same as if I had personally issued a cheque authorizing payments indicated and to debit the amount specified to my account.

48. 

50. By signing this document, I hereby agree to abide by County of Wetaskiwin No. 10 (the County) Utility Bylaws and Regulations in force, now and hereafter. Further, I expressly acknowledge that I have completely read and understood the terms and conditions stated, and I certify that all information is true and correct to the best of my knowledge.

52. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, and 2) by signing in this alternate manner, your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
54. Electronic Signature*
55. Date:*

57. The applicant hereby contracts with the County for electronic payment of the utilities applied for as described above. The applicant will pay the County through the UAPP program all amounts stated on the monthly utility billing for, and in consideration of these services provided by the County, until such time as the applicant applies in writing to discontinue the UAPP program or to have such services discontinued.

61. Protection of Privacy Act

    The personal information collected through this Utility Auto Payment Plan (UAPP) form is for the purpose of administering requests to register for the UAPP. This collection is authorized by Section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, please contact the County of Wetaskiwin Privacy Officer: email legislativeservices@county10.ca; telephone 780.352.3321.

    
    

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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit