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Tax Payment Pre-Authorization Form

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A taxpayer can set up payment plan for the 1st or 15th of the month or Semi-Monthly with the City by filling out a Pre-Authorization form and providing a void cheque or a Direct Deposit form from your financial institution. Due to COVID-19 restrictions the Pre-Authorization form is now available for completion via the website.

This form is to be used for the initial authorization to establish the PAD Option. If you have any questions about the PAD Option, please contact the City Collector, Michelle Walsh (709) 637-1568 or collector@cornerbrook.com. All personal information collected by this form are done so exclusively with your consent, by means of a form posted on our website, an email received from you or by telephone.

Month*
I/We hereby authorize the City of Corner Brook and the financial institution indicated to release funds for payment of personal property or business taxes starting the month of:
Payment Frequency*
I/We hereby authorize the City of Corner Brook and the financial institution indicated to release funds for payment of personal property or business taxes with the payment frequency of (all payments must be the 1st, the 15th or semi monthly):
Monthly/Semi-Monthly Payment Amount:*
I/We hereby authorize the City of Corner Brook and the financial institution indicated to release funds for payment of personal property or business taxes in the amount of:
Name*
First Last
Phone*
Email*
Municipal Address*
Street Address
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attach files*
Please Provide the Following Banking Information and include a voided cheque or Direct Deposit Form
Drop files here or

Max. file size: 64 MB.
Bank Account Type*
- Chequing
- Savings
Name of Financial Institution:*
Bank # (3 digits)*
Branch # (5 digits)*
Account Number*
Terms & Conditions*
Pre-Authorized Debit (PAD) Authorization

Terms and Conditions

1. This authorization may be cancelled at any time upon notice by me/us. I/We acknowledge that, in order to revoke this authorization, I/We must provide written notice of revocation by filling in the attached cancellation notice and submitting it to the City of Corner Brook at least 10 business days prior to the next scheduled PAD.

2. “I/We acknowledge that provision and delivery of this authorization to the City of Corner Brook constitutes delivery by that bank/financial institution. Any delivery of this authorization to you constitutes delivery by me/us.”

3. “I/We acknowledge that this Authorization is provided for the benefit of the City of Corner Brook and any such financial institution is provided in consideration of financial institution agreeing to process debits against my account in accordance with the Rules of the Canadian Payments Association”.

4. “I/We undertake to inform the City of Corner Brook, in writing, of any change in the account information provided in this authorization at least 10 business days prior to the next due date of the PAD”.

5. “I/We acknowledge that my financial institution is not required to verify that a PAD has been issued in accordance with the particulars of my/our authorization including, but not limited to, the amount.

6. “I/We acknowledge that my financial institution is not required to verify that any purpose of payment for which the PAD is issued has been fulfilled by the City of Corner Brook as a condition to honouring a PAD issued or caused to be issued by the City of Corner Brook on my/our account”.

7. “A PAD may be disputed by me/us under the following conditions: i) the PAD was not drawn in accordance with my/our Authorization; or ii) the authorization was revoked.

I/We acknowledge that interest will be applied on arrears effective January 1 at a rate of .875% per month (10.50% per annum). Interest will be applied retroactive to the invoice date on any current taxes unpaid by the due date.

I/We, in order to be reimbursed, acknowledge that a declaration must be completed and presented to the bank/financial institution holding my/our account up to and including 90 calendar days in the case of a personal household PAD after the date on which the PAD in dispute was posted to my/our account.

I/We acknowledge that a claim on the basis that my/our authorization was revoked, or any other reason, is a matter to be resolved solely between the City of Corner Brook and me/us when disputing any PAD after 90 calendar days in the case of a personal/household PAD.

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD agreement. To obtain more information on your recourse rights, contact you financial institution or visit www.cdnpay.ca
I agree to the terms and conditions
Receipt*
- Yes
- No
In order to reduce paper we will only send a receipt, if requested by you. Please indicate if you wish to receive your receipt:
Consent*
I agree to the privacy policy stated below.
The City of Corner Brook uses this web form to collect your information in order to better administer programs and services that citizens use and rely on. The City of Corner Brook committed to protecting the privacy of individuals who chose to utilize these services.
This information is collected in compliance with the Access to Information and Protection of Privacy Act, 2015 (ATIPPA, 2015) and will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose unless you expressly consent otherwise. This information is not disclosed to other public bodies or individuals except as authorized by ATIPPA, 2015.

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