Fillable Snow Removal Financial Assistance

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Snow Removal Financial Assistance

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Country of origin: CANADA
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Ensure you keep a copy for your records PAGE 4 Rev.SEP-2019
Snow Removal Financial Assistance
For Seniors & Physically Challenged Citizens
REIMBURSEMENT FORM
2020/2021 Winter Season November – April
Throughout the winter months, use this Reimbursement Form to track dates and the cost of each
service. For each service occurrence, you must obtain a signature from your service
provider and/or attach receipts. Sign, date and return your Reimbursement Form as soon as
you have paid out your maximum allowance. Incomplete forms will be returned.
IMPORTANT DATES
Your Application Form is due April 30, 2021.
Reimbursement Forms received after July 31, 2021 will not be processed.
Subsidy payments for this program will not commence until January 2021.
Name of Applicant:
Address: Postal Code:
Email Address:
Track Costs below (attach additional pages if necessary)
DATE OF SERVICE
COST INCURRED
SIGNATURE OF SERVICE PROVIDER
APPLICANT, SIGN AND DATE:
I hereby certify the above information is correct.
Signature of Applicant Date
The personal information on this form is collected under authority of Section 8 of the Municipal Act, S.O. 2001, c.25. The information will only be used for the purpose
of the administering the Snow Removal Financial Assistance Program. Questions about the collection of personal information should be directed to the Permits
Supervisor, Williams Parkway Operations Centre – 1975 Williams Parkway, Brampton ON L6S 6E5 – Telephone: 905.874.2500.
Mail or drop off completed form & receipts at:
City of Brampton, Public Works
1975 Williams Parkway, Brampton, ON L6S 6E5
Fax: 905.874.2599
Email a scanned copy to: roads@brampton.ca
You can also drop off form & receipts at:
Service Brampton – City Hall Kiosk
2 Wellington Street West
Brampton, ON L6Y 4R2
Inquiries:
905.874.2500 or 3-1-1
DD MM YYYY
ELECTRONIC FUNDS TRANSFER
Electronic Funds Transfer (EFT) is the City of Brampton’s preferred method of payment.
This ensures payments are directly deposited into your bank account the same day payment is
scheduled.
It ensures a secure, convenient and quicker receipt of payments.
To sign up for Electronic Funds Transfer, please fill in the attached Direct Deposit form and
return via email to accountspayable@brampton.ca.
If regular mail is preferred, mail to:
City of Brampton
2 Wellington Street W.
Brampton ON L6Y 4R2
Attention: Accounts Payable
Thank you
Accounts Payable
Corporation of the City of Brampton
ACCOUNTS PAYABLE
DIRECT DEPOSIT SET-UP FORM
(for Vendors)
STEP#1: VENDOR INFORMATION
Type of Request:
1
st
Time Set-up
Update of Information
Company Name:
Street Address:
City:
Province:
Postal Code:
Phone #:
(
)
STEP#2: ACCOUNT INFORMATION
OPTION-A (VOID CHEQUE ATTACHED) - For your payment to be deposited to your account please staple a
cheque to this form in this area and ensure the word VOID is written across the face of the cheque.
-- OR --
OPTION-B (WITHOUT A VOID CHEQUE) - For your payment to be deposited to your account please have your
bank provide and authorize the following information:
Bank Name:
Bank Addr:
Transit #:
Bank #:
Account #:
Bank authorization of above account
information:
STEP#3: REMITTANCE INFORMATION
Contact Phone #:
(
)
-
Remittance
Method:
(choose one)
Email*
Email Addr:
Fax
Fax #:
E.D.I. Remittance (Electronic Data Interchange)
None
* Please note: Email is not a secure form of communication and we cannot guarantee that your message will not be
viewed by someone else. Confidential banking information will NOT be included on email remittance advice (see
SAMPLE on reverse/next page).
STEP#4: SIGNATURE & DATE
I authorize The Corporation of the City of Brampton to deposit my Accounts Payable payments to the bank and
account and issue my remittance advice as indicated on this form.
Signature:
Date:
STEP#5: MAIL OR FAX THIS FORM
The personal information on this form is collected under
authority of the Municipal Act, SO 2001, c.25 and will be used
for the purpose of providing Direct Deposit payments for
City vendors. Questions about the collection of personal
information should be directed to the Accounts Payable
Supervisor, 2 Wellington Street West, 2
nd
Floor, Brampton,
Ontario, L6Y 4R2, Tel: 905 874 2239
Mail this form to:
City of Brampton
ATTENTION: Accounts Payable Supervisor
2 Wellington Street West, 2
nd
Floor
Brampton, Ontario
L6Y 4R2
or e-mail to accountspayable@brampton.ca
Rev.2010-10-19
CLEAR FORM
click to sign
signature
click to edit
ACCOUNTS PAYABLE
DIRECT DEPOSIT SET-UP FORM
(for Vendors)
Rev.2010-10-19
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Snow Removal Financial Assistance

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Completed 25 March 2022

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