Pre-Authorized Debit Plan
Agreement Cancellation Notice
Please complete this form and send to Utilities Kingston as follows:
By mail: Utilities Kingston, Attention: Customer Service Department, PO Box 790, Kingston, Ontario K7L 4X7
By fax: 613-546-7816
By email: firstname.lastname@example.org
This form of Cancellation Notice for the purposes of Canadian Payments Association Rule H1 -
Pre-Authorized Debits (PADs), does not preclude a Payor from using any communication in writing or otherwise that clearly
instructs a Payee to cease issuing PADs or otherwise revoking a Payor’s PAD Plan Agreement or authorization to issue PADs.
The provisions set forth below are in addition to and not in replacement of any or all provisions of any other agreement between
a Payee and a Payor and do not limit a Payor’s obligations under any agreement with a Payee that comply with the provision of
To request termination, notication must be received at least ten (10) business days before the next debit is scheduled for the
account number provided below.
PLEASE COMPLETE THE FIELDS, THEN PRINT AND SIGN
To: Email Address:
cancel my/our authorization to issue (personal) pre-authorized debits against my/our account
(Utilities Kingston Account Number)
edge that this cancellation does not terminate any other obligation that I/we may have with the Payee.
(Payor/Valid Signing Authority(ies)
Note: Subject to the terms of any agreement between a payor and Payee including their Payor’s PAD Agreement, a
Cancellation Notice may be provided to a Payee by way of registered mail, telephone, internet, email, fax or prepaid courier and
must be provided in compliance with the noticed requirements for cancellations, if any, set out in the applicable Payor’s PAD
For assistance, further information or, if you require this form in an
alternate format, please call 613 546 0000 or