Pre-Authorized Payment Cancellation Form

Please complete this form to authorize the cancellation of your Pre-Authorized Payment Plan.

To: Waterloo North Hydro Inc.
Name*
I/we, cancel my/our authorization to issue Pre-Authorized debits against my/our account number(s), listed below:
First Last
Email Address*
Account Number(s)*
Effective As Of:*
MM slash DD slash YYYY

I/We acknowledge that this cancellation does not terminate any other obligation that I/We may have with Waterloo North Hydro Inc.
Signature*
Where the Payor’s account agreement requires the signature of two or more signing authorities, the signatures of all such persons are required for the purposes of this Cancellation Notice.

To: Waterloo North Hydro Inc.