Required fields are marked with asterisks (*)

Pre-authorized Payment Change Form

This form is for the cancellation of a pre-authorized payment plan or to make a change to the banking information of an existing pre-authorized payment plan.

Please select the municipal account(s) affected by this change

Property Tax

Water and Sewer

Both

Effective date

Roll Number

Water Account Number

Name

Property Address

Telephone

Please select the change action you are requesting

Cancellation

Change of Bank Account

Change of PAP Plan (property tax accounts only)

Authorization

By submitting this form, I, as the account owner or legal representative, authorize the Municipality of Brighton to make changes to my Pre-authorized Payment Plan as outlined in this form.