Application for Electronic Data Interchange of Payments

1. Legal name of Taxing Authority (municipality, school board, province, or first nation's government):
2. Procurement Business Number unique to payments under the Payments in Lieu of Taxes Act.
3. Taxing Authority's Financial Institution Information
   1. Name of Financial Institution:
   2. Branch Number:
   3. Financial Institution Number:
   4. Account Number:
   5. Name of Account Holder:
   6. Financial Institution Stamp:
4. Authorized representative of Taxing Authority:
   1. Name:
   2. Title:
   3. Telephone Number:
   4. Fax Number:
   5. E-mail Address:

On completion, return this form to: Regional Manager, Payments in Lieu of Taxes, Public Works and Government Services Canada at the appropriate address:

Atlantic Region
1713 Bedford Row, 4^th Floor
P.O. Box 2247
Halifax, Nova Scotia
B3J 3C9
Fax: 902-496-5323

Quebec Region
Place Bonaventure, South-East Portal
800 de La Gauchetière Street West, Suite 7300
Montreal, Quebec
H5A 1L6
Fax: 514-496-3766

National Capital Area
191 Promenade du Portage, 6^th Floor
Gatineau, Quebec
K1A 0S5
Fax: 819-956-7490

Ontario Region
4900 Yonge Street, 10^th Floor
Willowdale, Ontario
M2N 6A6
Fax: 416-512-5553

Western Region
10025 Jasper Avenue, 5^th Floor, Rm 1000
Edmonton, Alberta
T5J 1S6
Fax: 780-497-3802

Pacific Region
641-800 Burrard Street, 15^th Floor
Vancouver, British Columbia
V6Z 2V8
Fax: 604-775-9364