Pre-Authorized Payment Plan Account Number*Customer Name* First Last Service Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Mailing Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code If different from Service AddressPhone*Business PhoneEmail* Payment Options*Pre-Authorized Chequing (1)Equal Payment Through Pre-Authorized Chequing (2)The account balance will be withdrawn from your designated bank account on the date indicated on each billing statement.Amount of monthly budget payment, to be determined Orillia Power Distribution Corporation (OPDC), will be withdrawn from your designated bank account, followed by an account reconciliation payment/credit in the 12th month of the program. The equal payment amount can be withdrawn on either the 3rd or 10th day of the month. To ensure the plan is consistent with customer usage, OPDC conducts a mid-year review to ensure that the monthly payment amount accurately reflects each participating customer’s consumption patterns and charges. If there is a significant difference OPDC notifies customers if a change to their monthly payment amount is required. Please specify below which date you would like your payment to be withdrawn:*3rd day of every month10th day of every monthAttach a “void” cheque with your application. Your account balance must be at a zero balance before commencing with either Plan. Once on the Plan, you will continue to receive OPDC bills as usual. This authority is to remain in effect until OPDC has receive written notification of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided above. Upon termination, ANY AMOUNT DUE shall be paid directly to OPDC. Cancellation of pre-authorized debit does not constitute cancelation of service by OPDC and the customer shall be liable for any past, present or future amounts owing. Void Cheque*Please upload a picture or scanned void cheque.Account Payment Agreement I agreeI/We hear by authorize OPDC to debit my bank/trust account for payments due. I/We acknowledge that insufficient funds may result in service charges as applicable and removal after two occurrences. I/We undertake to ensure sufficient funds will be available each month to cover the undersigned to OPDC in payment of my/our monthly billed services.