Required fields are marked with asterisks (*)

Enroll in pre-authorized payment program

By completing this form, I/we hereby authorize the Town of Tillsonburg to draw amounts from my/our financial institution for automatic bill payments.

Full Name/Company Name

Email address

Cycle

Account Number

Service Address

Telephone Number

Select your payment plan type:

Variable Payment Plan (Actual amount due)

Equal Payment Plan (Residential, SSS customer ONLY)