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Primary person on title who should receive the bills. (Note: only 1 person can be listed as primary owner)
Canadian Banks Only
Upload a copy of a void cheque.
Important: It is the responsibility of the account holder(s) to confirm that payments are being withdrawn from their bank account.
By my signature below I acknowledge that I have read and understood the following:
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, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Your personal information is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act. The personal information you provide on this form is being collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act. This information will be used for the purposes of collecting utility payments. This form is deemed transitory and will be destroyed upon cancellation of PUPP account. If you have any questions about the collection or use of this information please contact the FOIP Coordinator, at the MD of Bighorn at 403-673-3611.
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