Application For Automatic Bank Withdrawal Bank Account Change

Attach a Void Cheque or Authorized Bank Account Information

By checking "I agree," I hereby authorize the City of Medicine Hat and its Financial Institution to debit the bank account provided for the balance of the Utility account each month. I also acknowledge that the payment will be forwarded to the bank at least three (3) business days prior to the actual withdrawal date. I am also aware that bills with a total credit amount will result in no transaction activity on my bank account for that month.

If a payment is returned for any reason, I will be removed from the Automatic Bank Withdrawal Program. A deposit may be required.

I am aware that a minimum of 10 days is required to change the pre-authorized withdrawal information.

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.

Please note: If you pay your property taxes on TIPP and also need to update this bank account, you will need to complete a TIPP Bank Information Change form.