Submit a monthly contribution – please refer to the agreement below.
Address Line 1
Address Line 2
Province---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
14th of the month18th of the monthProcess date
Payment typePre-authorized debitCredit card
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Provide us with your account informationEnter account informationImage of a VOID cheque
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[group hcs-dms-void-cheque-image clear_on_hide]
Upload image of a VOID cheque
Notes for the finance office (optional)
I may revoke my authorization at any time, subject to providing 15 days notice. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution or visit www.canpay.ca.
I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.canpay.ca.