Required fields are marked with asterisks (*)

Electronic Funds Transfer Authorization Form

Instructions

Please complete form below and provide deposit account details and upload a VOID cheque or confirmation letter from your bank containing your Agency's account details.

This form will be submitted directly to: Town of Huntsville, Accounts Payable

Any questions can be directed via email to:

lori.allen@huntsville.ca or by calling

705-789-1751 ext. 2260

Vendor Information

First Name

Middle Name(s)

Last Name

Vendor Name

Unit Number

Street Number

Street Name

P.O. Box Number/ RR Number

City or Town

Postal Code/ ZIP Code

Phone Number

E-Mail Address

Type of Service

Business

Personal

Deposit Account Details

Name of Financial Institution

Civic Address of Financial Institution

Document Upload

Note: The maximum file size is 10 megabytes (mb). If your attachment(s) exceed the allowable file size, please contact the department by telephone at 705-789-1751 to arrange for an alternate method of sending the large documents.

Please Upload a VOID Cheque or Confirmation Letter

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Forms

Electronic Funds Transfer Authorization Form

Instructions

Vendor Information

Deposit Account Details