Form Builder

Landfill Credit Application Form

Terms & Conditions:

1. All invoices are payable 30 days from the date of the invoice.

2. Any outstanding invoices over 30 days will be subject to interest at the rate of 1.25% per month.

3. Any outstanding invoices over 60 days will result in credit privileges being revoked.

4. Any accounts still outstanding after 60 days will be collected in the following manner:

a) For property owners within the municipality a notice will be sent that if the account is not paid immediately the amount shall be collected in the same manner as municipal taxes.

b) For property owners outside the limits of the municipality a notice will be sent that if the account is not paid immediately, the account will be forwarded to outside sources to collect.

Applicant Name

Company Name (if applicable)

Application Date

Property Address (Street number and name)

Property Address (Town)

Property Address Postal Code (if applicable)

Is your mailing address the same as your property address?

Yes

Email Address

Phone Number

I/We hereby request the Township of Huron-Kinloss to set up an account for billing purposes.

Please sign

Clear

In accordance with the Municipal Freedom of Information and Privacy Act, personal information is collected under the authority of the Municipal Act, 2001 and will only be used for the purpose of reviewing credit applications. Questions about the collection of the personal information may be addressed to the Clerk at the Township of Huron-Kinloss, 21 Queen Street, P.O. Box 130, Ripley, ON, N0G 2R0 or (519) 395 3735.