PRE-AUTHORIZED DEBIT FOR ACCOUNT PAYMENTS This form may be used to authorize the automatic bank withdrawal (called a Pre-Authorized Debit or PAD) for amounts billed to you for user fees. PAD’s will be processed by 1473479 ONTARIO LIMITED o/a National PayDay on, after or before the due date. 1. I/We authorize 1473479 ONTARIO LIMITED o/a National PayDay and my/our noted Canadian bank/financial institution to withdraw from my/our account indicated in this form to cover payment in full for fees billed to me from time to time and/or outstanding debt– hereafter identified as PAD (pre-authorized debit) 2. I/We acknowledge that it is my/our sole responsibility to notify 1473479 ONTARIO LIMITED o/a National PayDay of any changes to my/our bank/financial account, street mailing address or e-mail address. 3. PAD agreements may only be changed or terminated in writing under signature of the original applicant. National Payday will accept a change/termination request by fax with the original applicant signature(s) for this purpose. 4. National PayDay may terminate this agreement at any time upon written notice (including e-mail notice where applicable). Upon termination, notification of billed charges will be by regular mail. I/We will make payments for billed amounts directly to National PayDay using methods that may be in effect at that time. 5. Notice of the Payment Amount and the Payment Date will be delivered to me at least 10 calendar days before the Payment Date. I/We recognize and agree that delivery of the Notice of Payment cannot be guaranteed and that delivery is made on a best efforts basis following the normal processing and mailing (e-mailing) procedures followed by National PayDay. Failure to deliver a Notice of Payment does not relieve me/us of our obligation to pay the amount owing under this agreement. 6. I/We acknowledge that the Processing Institution is not required to verify that a PAD has been issued in accordance with this Authorization, or that any purpose for which the PAD was issued has been fulfilled by National PayDay, as a condition to honouring a PAD issued by the National PayDay on my/our account. 7. I/We may dispute a PAD withdrawal only under the following conditions: a. I/We never provided authorization to National PayDay; b. The PAD withdrawal was not drawn in accordance with my/our authorization; c. My/Our authorization was revoked; or d. The withdrawal was posted to the wrong Canadian bank/financial institution due to incorrect financial information supplied to National PayDay. 8. I/We acknowledge that in order to be reimbursed, a declaration to the effect that either a), b), c) or d) took place must be completed and presented to the branch of the Processing Institution holding the Account up to and including 90 calendar days after the date on which the PAD in dispute was posted to the Account. 9. I/We acknowledge that when disputing any PAD beyond the time allowed in this section, it is a matter to be resolved solely between me/us and National PayDay, outside the payment system. 10. I/We agree that the PAD information contained in this Authorization may be disclosed to any current banking institution used by National PayDay for the purposes of making these pre-authorized withdrawals. Please Print Service location address: Last Name First Name Account # Mailing City Province Postal Code Daytime Telephone Number A. COMPLETE THIS SECTION TO ALLOW THE PRE-AUTHORIZED DEBIT OF ACCOUNT PAYMENTS (PAD): I/We warrant and represent that the following information is accurate: Name of Canadian Banking/Financial Institution Street Address of Banking/Financial Institution City Province Postal Code Bank Account Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Institution No. Transit No. Account Number Please attach a cheque marked VOID to this PAD authorization. If you do not have a chequing account, please have the above noted information completed by your banking institution. I/We warrant and guarantee that all persons whose signatures are required to authorize withdrawals from the account have signed the Authorization below. I/We acknowledge that this constitutes delivery by me/us to the noted Canadian bank/financial institution. ________________________________ ____________________________________ Signature Date: ___________________________ |
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