test-pad

    PERSONAL INFORMATION

    As an added security feature, please choose a personal password that you will provide when accessing account information by telephone-up to 10 letters (suggest mother’s maiden)


    BANK INFORMATION

    – Please choose one of the following:

    Or, 2) If your account does not provide cheques, please have your bank fill out the information below to
    ensure the account is coded correctly and will allow pre-authorized payment.

    ATTACH VOID CHEQUE HERE

    AUTHORIZATION

    By submitting this authorization, I/We acknowledge that I/we) have read, understood and accepted all the provisions in the Terms and Conditions on Page 1 of this Pre-authorized Debit Agreement, a copy of which has been provided toand retained byme/us.

    PLEASE NOTE THIS FORM MUST BE RECEIVED NO LATER THAN THE 15TH OF THE MONTH PRIOR TO THE MONTH THE PAD IS TO COMMENCE. Since the PAD program is not retroactive, pleaseenclose a cheque for any balance owing prior to PAD commencement OR to attach a note authorizing our office to do a one time sporadic “catch-up” payment.

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