Name: The Town Of High River
Price range: $

Home Form Testing

Form Testing

Connect or Disconnect Residential Property Services

How are you associated with this property? *

Residential Tenants are NOT allowed to apply for utilities. It must be the property owner.

Owner

Tenant

Residential Tenants are NOT allowed to apply for utilities. Please have the owner of the property submit this form to apply for utilities.

Owner Information

Possession Date

Property Owner Full Name: *

First Name *

Last Name *

Property Owner Email: *

Property Owner Phone Number: *

Service Address:

Service Address: *

City *

ZIP / Postal Code *

Is the Mailing Address different from the Service Address?

Yes - The address is different

No - The addresses are the same

Property Owner Mailing Address (If different from the service address):

Address 1

City

ZIP / Postal Code

State / Province

Country

Is there a secondary contact for this property?

Yes

Secondary Contact

Secondary Contact Full Name:

First Name

Last Name

Secondary Contact Email:

Secondary Contact Phone Number:

I Would Like To:

Connect Residential Services

Disconnect Residential Services

Is this a New Build?

Yes

(New Builds Only) What size of garbage can would you like:

*There is a garbage bin size change fee of $31.86 if you later decide to change the size of your bin.

240L Bin

360L Bin

Would you like to sign up for Pre-Authorized Payments?

Yes

Would you like to cancel Pre-Authorized Payments?

Yes

Cancelling Pre-Authorized Payments

Full Name:

First Name

Last Name

Utility Account Number:

This line may be left blank; Town staff will complete it if needed.

Tax Roll Number:

This line may be left blank; Town staff will complete it if needed.

Accounts Receivable Number:

Account Number for All Other Town Services (i.e. housekeeping, rent, business license, etc.) This line may be left blank; Town staff will complete it if needed.

Would you like to cancel pre-authorized payments for your Utilities Account? *

*FINAL utility invoices can NOT be pre-authorized for withdrawal from your bank account unless the invoice due date coincides with the usual utility billing due dates which are the last business day of Jan, Mar, May, July, Sept, and Nov. Final Utility invoices will be generated approximately 1 to 2 weeks after your possession date and are due 3 weeks after the invoice date.

Yes

Would you like to cancel pre-authorized payments for your Tax Account? *

Yes

Would you like to cancel pre-authorized payments for your Accounts Receivable Account?

Yes

What month would you like the cancelation of your Tax Installment Payments to take affect? *

When do you want your last TIPP payment withdrawn? *

When do you want your last Accounts Receivable payment (i.e. housekeeping, rent, business license, etc.) withdrawn?

Pre Authorized Payment Agreement:

I acknowledge that (by selecting I Agree), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Set Up Pre-Authorized Payments Information

Are you registering or changing your Pre-Authorized Payments?

Registering

Changing

Utility Account Number:

This line may be left blank; Town staff will complete it if needed.

Tax Roll Number:

This line may be left blank; Town staff will complete it if needed.

Accounts Receivable Number:

(i.e. housekeeping, rent, business license, etc). This line may be left blank; Town staff will complete it if needed.

What accounts do you want to register?

Please select all accounts that you would like to register for pre-authorized payments.

Utilities Account

Property Tax Account

What accounts would you like to change?

Please select all account types you would like to change.

Utilities Account

Property Tax Account

What month would you like your preauthorized payments to take affect?

Please see the Terms & Conditions above for details.

Current Tax Levy:

This amount can be found on your most recent Property Tax notice or by calling (403) 652-2110.

Amount per month to be withdrawn $

To be withdrawn over 12 months. This section applies to Property Tax payments only as Utility payments will match an invoice amount.

NOTE: The Tax Account’s balance owing must be paid in full at the time of signing up for TIPP in order to keep the account current and in good standing.

Banking Information

Using the Sample Cheque pictured below, match the numbers on the image to the descriptive text above the picture to make sure you’re submitting the correct information from your cheque.

A: This is the cheque number (do not enter this number)
B: This is the transit/branch number (5 digit number).
C: This is the institution number (3 digit number).
D: This is the account number. Please include any zero’s (0) that precede the numbers.

Financial Institution: *

Institution Number: *

Branch Transit Number: *

Account Number: *

Pre Authorized Payment Agreement *

I acknowledge that (by selecting I Agree), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Are you cancelling the pre-authorized payments because you have sold the property?

Yes

If Yes, please provide the possession date:

Would you like your Utility Invoices emailed to you:

Yes

Would you like your Property Tax Notices emailed to you?

Yes

Would you like your invoices for other Town services emailed to you?

Yes

Do you require an animal license? *

(Please note your first initial animal license(s) will need to be collected and paid for at Town Hall and then will be renewed annually in January of each year)

Yes

Animal License

Please note your first initial animal license(s) will need to be collected and paid for at Town Hall and then will be renewed annually in January of each year

Do you need to cancel an animal license?

Yes

If you selected "Yes" to cancelling a Animal License, please provide the animal license number: *

By selecting I AGREE - I consent that the notices, bills, invoices and communications for my above accounts will be provided by email to the email address listed above, and I will no longer receive a paper copy. I understand that it is my responsibility to provide the correct email address and to inform the Town of High River in writing of any changes to this email address. I understand that non-receipt of my notices, bills or invoices is not justification for late payment, and penalties will not be waived as a result.

Do you agree to the above statement? *

I AGREE

Verification *

I acknowledge that (by displaying/typing my name above), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Electronic Messaging

YES, I would like to receive electronic messages from High River Finance and the Town of High River, including email communications. These messages relate to utilities and tax assessments and notices in the Town of High River and will be sent for the purpose of communicating information about Town of High River utility and tax operations. I understand that I may unsubscribe from this distribution list at any time by emailing corporateservices@highriver.ca and noting the withdrawal of my consent to receive commercial electronic messages from High River Finance and the Town of High River.

The information collected via this form is being collected by the Town of High River pursuant to legislation governing the information handling practices of the Town of High River, specifically Sections 4(a) and (c) of the Protection of Privacy Act (Alberta), the Municipal Government Act (Alberta), and other legislation or bylaws governing the municipality, as may be applicable. By submitting this form, you acknowledge that in accordance with Section 20(2)(a) of the Access to Information Act (Alberta), your name, address and other details related to your request will be used to process your request. Should you have any questions relating to the collection or disclosure of your personal information, please contact Privacy Officer for the Town of High River at ATIPP@highriver.ca or 403-652-2110

Leave this field blank

Connect or Disconnect Commercial Property Services

Commercial Ownership Change *

Connect (New Owner)

Disconnect (Prior Owner)

Possession Date: *

Owner Full Name: *

First Name *

Last Name *

Company Name: *

Service Address:

Service Address: *

City *

ZIP / Postal Code *

Owner Email: *

Owner Phone Number: *

Is the Mailing Address different from the Service Address? *

Yes

Owner Mailing Address (If different from the service address):

Address 1

City

ZIP / Postal Code

Would you like to set up Pre-Authorized Payments?

Yes

Would you like to cancel Pre-Authorized Payments?

Yes

Cancelling Pre-Authorized Payments

Full Name:

First Name

Last Name

Utility Account Number:

This line may be left blank; Town staff will complete it if needed.

Tax Roll Number:

This line may be left blank; Town staff will complete it if needed.

Accounts Receivable Number:

Account Number for All Other Town Services (i.e. housekeeping, rent, business license, etc.). This line may be left blank; Town staff will complete it if needed.

Would you like to cancel pre-authorized payments for your Utilities Account?

Yes

Would you like to cancel pre-authorized payments for your Tax Account?

Yes

Would you like to cancel pre-authorized payments for your Accounts Receivable Account?

Yes

What month would you like the cancelation of your Tax Installment Payments to take affect? *

When do you want your last TIPP payment withdrawn? *

When do you want your last Accounts Receivable payment (i.e. housekeeping, rent, business license, etc.) withdrawn?

Pre Authorized Payment Agreement:

I acknowledge that (by selecting I Agree), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Set Up Pre-Authorized Payments

Pre-Authorized Payment Information

Are you registering or changing your Pre-Authorized Payments?

Registering

Changing

Utility Account Number:

This line may be left blank; Town staff will complete it if needed.

Tax Roll Number:

This line may be left blank; Town staff will complete it if needed.

Accounts Receivable Number:

(i.e. housekeeping, rent, business license, etc). This line may be left blank; Town staff will complete it if needed.

What accounts would you like to register?

Please select all accounts for which you would like to set up pre-authorized payments.

Utilities Account

Property Tax Account

Accounts Receivable

What accounts would you like to change?

Please select all accounts for which you would like to change pre-authorized payments.

Utilities Account

Property Tax Account

Accounts Receivable

What month would you like your preauthorized payments to take affect?

Please see the Terms & Conditions above for details.

Current Tax Levy:

This amount can be found on your most recent Property Tax notice or by calling (403) 652-2110.

Amount per month to be withdrawn $

To be withdrawn over 12 months. This section applies to Property Tax payments only as Utility payments will match an invoice amount.

NOTE: The Tax Account’s balance owing must be paid in full at the time of signing up for TIPP in order to keep the account current and in good standing.

Banking Information

Using the Sample Cheque pictured below, match the numbers on the image to the descriptive text above the picture to make sure you’re submitting the correct information from your cheque.

Financial Institution: *

Institution Number: *

Branch Transit Number: *

Account Number: *

Pre Authorized Payment Agreement *

I acknowledge that (by selecting I Agree), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Are you cancelling the pre-authorized payments because you have sold the property?

Yes

Possession Date:

Has/Is there a change of commercial tenants?

Yes

Commercial Tenant Change

Connect New Commercial Tenant

Disconnect Commercial Tenant

Effective Date:

Tenant Full Name:

First Name

Last Name

Tenant Company Name:

Tenant Email:

Tenant Phone Number:

Tenant Mailing Address (If different from company address):

Address 1

City

ZIP / Postal Code

Comments:

Do not email owner statement, only tenant statement etc.

Would you like your Utility Invoices emailed to you? *

Yes

Would you like your Property Tax Notices emailed to you? *

Yes

Would you like your Tenant Statement emailed?

Yes

Do you agree to the above statement? *

I Agree

Verification *

I acknowledge that (by displaying/typing my name above), I am signing this application, and I agree to be bound as if I had endorsed this document with my own handwritten signature.

Electronic Messaging

Leave this field blank

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Form Testing

Connect or Disconnect Residential Property Services

Owner Information

Connect or Disconnect Commercial Property Services

Pre-Authorized Payment Information

Banking Information