Pre-authorized Payment Program Authorization Form
TERMS & CONDITIONS a) I authorize the Payee to debit my account as indicated on the attached "void" cheque under the terms and conditions agreed to me with the Payee until such time as written notice to the contrary is given. b) I acknowledge that delivery of my authorization to the Payee constitutes delivery by me to the branch of the financial institution at which I maintain an account and that such financial institution is not required to verify that the payment (s) are drawn in accordance with this authorization. Termination of this authorization may/may not terminate the contract for good and services provided. c) You the Payor may revoke your authorization at any time, subject to providing notice prior to the 23rd of the month you wish to cancel the PAD. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit www.cdnpay.ca. d) I will notify the Payee in writing of any changes to the account information or termination of this authorization prior to the 23rd of the month preceding the next pre-authorized debit. e) I agree to replace any insufficient funds plus any applicable NSF fee with a certified cheque or money order. f) I acknowledge that if there are insufficient funds on the first of the month, a second attempt will be made to withdraw the funds. I recognize that my financial institution may charge an additional NSF fee should there be insufficient funds upon this second attempt. Items charged under any of the following conditions will be reimbursed subject to written notification by me to the branch of account within 90 days. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.dncpay.ca. a) I never provided authorization to the Payee. b) The pre-authorized debit was not drawn in accordance with my authorization. c) My authorization was revoked. d) The debit was posted to the wrong account due to invalid/incorrect account information supplied by the Payee. I warrant that all persons whose signature(s) are requested to sign on this account have signed this agreement.
Boardwalk REITResident Member Handbook bwalk.com Boardwalk 200 – 1501 1st St. SW
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