Transcription of TD Visa - TD Canada Trust - Personal, Small Business ...
1 Cancellation of authorization as ofMonth/Day/YearNew enrollmentChange in authorizationFinancial Institution:Mailing address:City:Province/State:Postal code:Telephone number:2. Payment Options(Check one)Savings account1. Cardholder Information(Please print clearly)Name:522740 (0609)3. Pre-Authorized Debit (PAD) Account InformationAccount Balance, in fullDeposit Account Number:VisaAccount number:Minimum PaymentChequing accountTransit number:AddressNameIn this authorization, "you" and "your" refer to each holder of the PAD account who signs this Form. Other terms have themeanings set out in the Pre-Authorized Payment Agreement. Youauthorize us to debit the PAD account for all amounts owed to usfrom time to time under the TDVisaAccount for the payment amount indicated under Payment Options on the Form. You haveread, understand and agree to the the terms of the Pre-Authorized Payment Agreement which forms part of this must include a 'VOID" cheque for a Chequing Account or the top portion of your statement for a Savings Account.
2 Yourapplication cannot be processed without Joint Account, all authorized signatures are of joint accountholderWhen the form is complete, mail or fax to:Signature of accountholderDate(Month/Day/Year)Name(Pl ease print)Date(Month/Day/Year)Name(Please print)Bank of Canada Number:TD Credit Box 300TD CentreToronto, Ontario M5K 1K6 Fax: 1-866-785-2485 or (416) 307-1341 IMPORTANTTDVisaPre-Authorized PaymentFinancial Institution number.
