Transcription of PayorInformation (pleasetypeorprintclearly)
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Example: bachelor of science
PayorInformation (pleasetypeorprintclearly)
Payor s PAD AgreementPersonal Pre-Authorized Debit PlanAuthorizationofthePayortothePayeetoD irectDebitanAccountInstructions:1. Returnthecompletedformwithablankchequema rked VOID Ifyouhaveanyquestions, Information(please type or print clearly)PayorNamePayorNameAddressAddress ()() Financial Institution/Banking Information(please type or print clearly)Payee Information(please type or print clearly)Payment (s)AddressCity/ProvincePostalCode() #orAccount#ServiceorUtilityStartDate9105 2001001 Pleasespecifywhetherthepaymentisa:(Pleas echeckone)FixedAmount:(Pleasespecify)Var iableAmount.
PAYOR’SPADAGREEMENT PersonalPre-AuthorizedDebitPlan Terms&Conditions 1. InthisAgreement,“I”,“me”and“my”referstoeachAccountHolderwhosignsbelow.
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