SCHEDULE "3" TO BYLAW NO. 2351
PERSONALLY APPROVED PAYMENTS SERVICE

The undersigned hereby authorize(s) THE CORPORATION OF THE CITY OF PORT
COQUITLAM on the i5th day of each month to draw monthly cheques or prepare
debits, by paper or electronic entry, covering payments due by the undersigned
to THE CORPORATION OF THE CITY OF PORT COQUITLAM for tax payments in the
amount of $ per month to cover property taxes and ‘flat rate
utility billings for ‘the current ‘ax year. This amount can be changed in
subsequent vears Dy mutual consent.

For

Address Number

DESCRIPTION OF TAXPAYER AND ACCOUNT

FIRST NAME INITIALS FAMILY NAME
(or corporate name if applicable)

PROVINCE POSTAL CODE

The undernoted financial institution:

NAME OF FINANCIAL INSTITUTION BANK BRANCH BRANCH _ #

wm.

ADDRES _ CITY PROVINCE POSTAL CODE

ig hereby authorized to pay and debit the account of the undersigned all
amounts payable to THE CORPORATION OF THE CITY OF PORT COQUITLAM drawn on or
directed to you by a chartered bank on behalf of tne undersigned.

Your treatment of each debit shall be the same as if the undersigned has
personally directed you to pay as indicated and to charge the amount specified
to the account of the undersigned.

This authorization may be cancelled at any time upon written notice.

Any delivery of this authorization to you constitutes delivery by the
undersigned.

Signature(s)

To ensure accuracy, Tf joint account, all depositors must
enclose a specimen sign if. more than on signature is. required
marked "VOID". on cheques issued against ‘he account. —

"06