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Required fields are marked with asterisks (*)

Direct Deposit Authorization Form

All fields labeled with an asterisk are mandatory and must be completed before your application may be submitted.

Please complete this form to sign up for Direct Deposit or change your existing banking information with the Corporation of the City of Brantford.

Please be advised that personal information collected is intended to be used to respond to your enquiry or complaint and is collected under the authority of section 10 (1) of the Municipal Act, 2001. Should you have questions about the collection of this personal information, please contact the City of Brantford’s Finance team at 519-759-4150 ext.5806 or email ap@brantford.ca

Contact information:

Business name

Business street address

City/Town

Postal code

Contact name

Phone number

Email address

Re-enter email address

I would like to:

Change my banking information for direct deposit