Required fields are marked with asterisks (*)

Pre-authorized Payment Cancellation Form

Please use this form to cancel your utility and/or tax preauthorized payment information.

Cancellations will take effect on the date indicated. Please remember that utility and tax payments are processed on the last buisness day of each month and may take a day or two before being processed by your bank.

Any balance due on the account at the time of the cancellation will not be processed and must be paid in person at City Hall, using your City of Yellowknife account , through online banking or by calling Customer Service at 867-920-5600 Ext. 0.

Name of Primary Occupant

Mailing Address

City & Province

Postal Code

Home Phone

Work Phone

Email Address

Cell Phone

Fax

Service Address

Would you like to cancel your Utility or Tax Preauthorized Payment?

Utility

Taxes

Both

When would you like your preauthorized payment cancellation to take effect?

After Final Bill

Immediately

Specific Date

Other

DECLARATION:

The above information, to the best of my/our knowledge, is true. Should the information change, I/we shall notify the City of Yellowknife. It is understood and agreed that permission hereby applied for is subject to compliance with the By-Laws of the City of Yellowknife.

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Pre-authorized Payment Cancellation Form

DECLARATION: