Utilities pre-authorized direct withdrawal cancellation

Required fields are marked with asterisks (*)

Applications to cancel utility direct withdrawals must be received by the 20th of the month.

Personal information provided is collected by Leduc County under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act (the FOIP Act) and we will protect it in accordance with Part 2 of that Act. We will use it to manage your account with us and contact you if necessary.

Should you require further information about collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780-770-9251 or foip@leduc-county.com.

Applicant information

Applicant name *

Phone *

Applicant address *

Town/city *

Province: *

Postal Code: *

Effective date *

Email address *

Property information

Account number *

Service address:

Town/city

Province:

Postal Code:

Signature

I hereby authorize Leduc County to discontinue direct debit withdrawls from my bank account and remove me from the utilities direct withdrawal program.

I understand that upon withdrawal from the program, all applicable utility due dates and penalties will apply.

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