Required fields are marked with asterisks (*)

Electronic Funds Transfer Application Form

Please note this form is intended soley for vendors to whom the Township of Algonquin Highlands is making payments. It is not a means to make payments to the Township.

Township of Algonquin Highlands
1123 North Shore Road
Algonquin Highlands, ON
K0M 1S0

Tel: 705-489-2379
Fax: 705-489-3491
Email: finance@algonquinhighlands.ca

Section A: Vendor Information

Name

Address

City

Province

Postal Code

Email Address for Payment Details

Section B: Banking Information OR send a copy of a void cheque

Name of Financial Institution

Transit Number

Institution Number (3-digit number)

Account Number

Section C: Company Authorization

I/We authorize the Township of Algonquin Highlands to deposit all payments to the above bank account and forward remittances to the email address indicated until notified of a change. Two authorization signatures are required to safeguard your organization.

Name

Title

Phone Number

Title

Phone Number

Signature

Clear

Date

Signature

Clear

Date

Please select if sole proprietorship and only one signature is available.

Yes

I/We authorize the Corporation of the Township of Algonquin Highlands to make all payments by electronic funds transfer into the above bank account. I/We have the authority to provide the above information on behalf of the corporation/organization/payee. I/We agree that the Corporation of the Township of Algonquin Highlands will not be liable for any loss occuring after the payment has been made to the identified account. I/We agree that any direct deposits made to this account in error will be promptly returned to the Corporation of the Township of Algonquin Highlands.

Keep up to date with everything happening in Algonquin Highlands by receiving regular updates to your inbox!

Subscribe now!