Pre-authorized payment plan

Fill and submit the form below to authorize Hydro Westmount to debit your bank account automatically according to pre-arranged terms. Before completing the form, make sure you have the following on hand: your Hydro Westmount account number and your bank account information.

Please note that you may revoke this authorization at any time, given two (2) weeks’ notice, by sending a written notice by email to serviceshydro@westmount.org.

Contract holder information

First name•

Last name•

Email•

Telephone

Hydro Westmount account number•

This 7-digit number can be found at the top of your Hydro Westmount bill.

Hydro Westmount client number

This 6-digit number can be found at the top of your Hydro Westmount bill.

Address of the service contract

Number and street•

Apartment or suite

Postal code

Payment information

Equalize Payment Plan (EPP)•

The EPP allows you to pay your estimated consumption in 12 equal monthly payments (adjusted annually according to actual trends).

Yes

Payment date•

Please choose from the options below the date of the month on which the equal payments will be made.

The 1st of each month

The 15th of each month

The 25th of each month

The withdrawal will be made according to the due date indicated on the invoice. Make sure funds are available in your account from two (2) days before, and until two (2) days after, the due date to account for processing time.

Banking information

Name of the financial establishment•

Branch address

Number and street name•

Apartment or suite

City•

Province•

Postal code•

Please enter your cheque information in the corresponding fields.

Transit branch number•

5 digits

Financial institution number•

3 digits

Account number•

Name of cheque holder and signatory

First name•

Last name•

Statements

I have taken care to enter the correct banking information and I recognize that I am liable for any fees related to a return of payment or insufficient funds situation caused by entering the wrong information. •

I confirm that the information provided is accurate and I authorize Hydro Westmount to verify any details related to this request for service. •

Date•

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