Transcription of PayorInformation (pleasetypeorprintclearly)
1 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:Ifvariable,pleasespecifywhet herthereisamaximumamount,orindicateN/Aif thereisnomaximumAmount:Occurringat:(Plea secheckone)SetIntervals:Pleasespecifythe timing( ,bi-weekly,monthly)SporadicIntervals:Are top-upsoradjustmentspermissible?(Pleasec heckone) (01/10)PAYOR S PAD AGREEMENTP ersonal Pre-Authorized Debit PlanTerms & Conditions1. InthisAgreement, I , me and my I agree to Bank of Montreal and any successor or assign of the Bank (the "Bank") debiting my account indicated on thereverse(the"Account")forpersonal/hous eholdorconsumerpurposesandIauthorizetheP ayeeindicatedonthereverseandanysuccessor orassignofthePayeetodrawadebitinpaper,el ectronicorotherform,includinganytop-upso radjustments,for the purpose of making payment for consumer goods or services (a "Personal PAD"), on my Account at the financialinstitutionindicatedontherevers e(the"FinancialInstitution")andIauthoriz etheFinancialInstitutiontohonourandpaysu chdebits.
2 ThisAgreementandmyauthorizationareprovid edforthebenefitofthePayeeandmyFinancialI nstitutionandareprovidedinconsiderationo fmyFinancialInstitutionagreeingtoprocess debitsagainstmyAccountinaccordancewithth eRulesoftheCanadianPaymentsAssociation. IagreethatanydirectionImayprovidetodrawa PersonalPAD,andanyPersonalPADdrawninacco rdancewiththisAgreement,shallbebindingon measifsignedbyme,and,inthecaseofpaperdeb its, the amount that I am required to pay under my agreement with the Payee changes, this authorization will continue may revoke authorization at any time, subject to providing notice to the Bank: this authority is to remain in effectuntiltheBankhasreceivedwrittennoti ficationfrommeofitschangeortermination. Thisnotificationmustbereceivedatleast 30 days before the next debit is scheduled at any branch of the Bank of Montreal. I may obtain a sample PADcancellation form or more information on my right to cancel a PAD Agreement at any branch of my financial institution authorization applies only to the method of payment and I agree that cancellation of this authorization does IagreethatmyFinancialInstitutionisnotreq uiredtoverifythatanyPersonalPADhasbeendr awninaccordancewiththisAgreement,includi ngtheamount, I agree that delivery of this Agreement to the Payee constitutes delivery by me to my Financial Institution.
3 I agree that thePayeemaydeliverthisAgreementtothePaye e (a) Iunderstandthatwithrespectto:(i) fixedamountPersonalPADsoccurringatsetint ervals,Ishallreceivewrittennoticefromthe Payeeoftheamounttobedebitedandtheduedate (s)ofdebiting,atleastten(10)calendardays beforetheduedateofthefirstPersonalPAD,an dsuchnoticeshallbereceivedeverytimethere isachangeintheamountorpaymentdate(s);(ii ) variable amount Personal PADs occurring at set intervals, I shall receive written notice from the Payee of theamount to be debited and the due date(s) of debiting, at least ten (10) calendar days before the due date of everyPersonalPAD;and(iii) fixedamountandvariableamountPersonalPADs occurringatsetintervals,wherethePersonal PADP lanprovidesforachangeintheamountofsuchfi xedandvariableamountPADsasaresultofmydir ectaction(suchas,butnotlimitedto,ateleph oneinstruction)requestingthePayeetochang etheamountofaPAD, OR -(b) Iagreetowaivethepre-notificationrequirem entsinsection6(a) I agree that with respect to Personal PADs, where the payment frequency is sporadic, a password or secret code or othersignatureequivalentwillbeissuedands hallconstitutevalidauthorizationforthePa yeeoritsagenttodebit Icertifythatallinformationprovidedwithre specttotheAccountisaccurateandIagreetoin formthePayee,inwriting,ofanychangeintheA ccountinformationprovidedinthisAgreement atleastten(10)businessdayspriortothenext duedateofaPersonalPAD.
4 Intheeventofanysuchchange, ,whereapplicable,thatIhavetheauthorityto electronicallyagreetocommittothis Agreement by secure electronic signature and that my secure electronic signature conforms with the requirements Applicable to the Province of Quebec only: It is the express wish of the parties that this Agreement and any relateddocumentsbedrawnupandexecutedinEn glish. Lespartiesconviennentquelapr senteconventionettouslesdocumentss yrattachantsoientr dig setsign Ihavecertainrecourserightsifanydebitdoes notcomplywiththisPADA greement. Forexample, , ,andunderstandthatthispre-authorizeddebi tformmaynotbeprocessedbythepayeeorthepay ee ,PayormustsignwhereindicatedDeleteeither 6(a)or6(b)asapplicabl
