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Pre-Authorized Utility Payment Plan Application

  1. The City of Chestermere offers you a simple, easy method of payment through our Pre-authorized Payment Plan. Skip standing in line, writing monthly cheques and paying for postage by using this convenient plan that authorizes automatic monthly deductions of your utility bill from your bank account.

  2. This program is NOT compulsory and you may opt out of the pre-authorized payment plan at any time.

  3. How will you know what deductions are being made from your account?

    Under the Pre-authorized Plan you will continue to receive a bill showing the amount that will be deducted from your bank account. The withdrawal from your bank account will be the 27th day of the month the bill is due or the following business day if the 27th falls on a weekend. If you have any questions about your billing, please call 403-207-7070. We can also be reached by email at

  4. What if you move, change banks or decide to cancel the plan?

    If for any reason you need to change or cancel the Pre-authorized Payment Plan, send the request in writing to the City and we will make the changes you need. Please inform us of these changes a minimum of five working days prior to the due date on your bill.

  5. How do you apply the Pre-authorized Payment Plan?

    1. Complete the form below. 2. Sign the application form. 3. Return the completed form, along with a copy of a void personalized cheque clearly showing the bank account number to be used to: or at City Hall: 105 Marina Road, Chestermere, AB T1X 1V7.

  6. To join our Pre-authorized Payment Plan, please complete and return this application with a void cheque.

  7. Service Agreement:

    I/we authorize the City of Chestermere to begin automatic withdrawals for payment of my/our monthly City utility bill from the bank account number identified on the enclosed cheque. This authority is to remain in effect until there is notification of termination from the customer.

  8. Are you a tenant or owner?:

  9. (xxx) xxx-xxxx

  10. (xxx) xxx-xxxx

  11. Located on the top portion of your bill:

  12. Please print your name:

  13. For joint account where more than one signature is required on cheques, all required signatures must be provided.

  14. Please print this form and drop off a void cheque to our City Hall Location

    If you cannot submit the form and cheque in person, please submit the them via our drop box in an envelope addressed to the utilities department.

  15. Leave This Blank:

  16. This field is not part of the form submission.