Form Builder

Required fields are marked with asterisks (*)

Utility Bill-Pre-Authorized Debit Plan Agreement

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

Name(s)

Service Address

City/Town

Postal Code

Phone Number (Res)

Phone Number (Bus)

Email Address

Re-Enter Email Address

Customer Account Number (16 digit)

Re-Enter Customer Account Number

Type of Service

Personal

Business

I would like to:

Change my banking information for my preauthorized payment plan

Terminate my preauthorized payment plan

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 of the Municipal Act, 2001.

City of Brantford
Telephone: 519-756-1360
E-mail: customerservices@brantford.ca