HOW WILL YOU BE PAYING. ❑ Credit Card on File ❑ Employee will call for Credit Card no. ❑ Cheque (dropped at office) ❑ Debit (at Office) Office Use Transaction No.: Received by: Staying at Pike Lake for 100 days or greater in any season. ❑ YES Fee of $500.00 +HST (Invoiced June 15th every year) 2022 PRE-AUTHORIZED DEBIT AGREEMENT FORM ACCOUNT HOLDER INFORMATION BANK ACCOUNT INFORMATION Name: ❑ Void cheque already on file Address: or ❑ Will email new void cheque to xxxxxx@xxxxxxxx.xxx ❑ Will email form from bank to xxxxxx@xxxxxxxx.xxx City/Prov. Postal Code: You, the Payor, authorize Pike Lake Golf Centre Limited to debit the bank account identified above for the fixed amount of $324.87 on the 15th of every month for 12 consecutive months beginning Sept. 15, 2021 to and including Aug. 15, 2022. The office must be contacted 10 days prior to a payment date for any banking account changes. Any returned payment will result in a $75.00 NSF Charge + applicable taxes. You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of no less than 15 days. To obtain a sample cancellation form or for more information on your right to cancel a Pre-Authorized Debit Agreement, contact your financial institution or contact xxx.xxxxxx.xx Signature of Account Holder Date You have certain recourse rights if any debit does not comply with this agreement. To obtain more information on your recourse rights, contact your financial institution or visit xxx.xxxxxx.xx.
Appears in 1 contract
Samples: pikelake.com
HOW WILL YOU BE PAYING. ❑ Credit Card on File ❑ Employee will call for Credit Card no. ❑ Cheque (dropped at office) ❑ Debit (at Office) Office Use Transaction No.: Received by: Staying at Pike Lake for 100 days or greater in any season. the coming season ❑ YES Fee of $500.00 +HST (Invoiced June 15th every year15, 2021) 2022 2021 PRE-AUTHORIZED DEBIT AGREEMENT FORM ACCOUNT HOLDER INFORMATION BANK ACCOUNT INFORMATION Name: ❑ Void cheque already on file Address: or ❑ Will email new void cheque to xxxxxx@xxxxxxxx.xxx ❑ Will email form from bank to xxxxxx@xxxxxxxx.xxx City/Prov. Postal Code: You, the Payor, authorize Pike Lake Golf Centre Limited to debit the bank account identified above for the fixed amount of $324.87 365.84 on the 15th of every month for 12 consecutive months beginning Sept. 15, 2021 2020 to and including Aug. 15, 20222021. The office must be contacted 10 days prior to a payment date for any banking account changes. Any returned payment will result in a $75.00 NSF Charge + applicable taxes. You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of no less than 15 days. To obtain a sample cancellation form or for more information on your right to cancel a Pre-Authorized Debit Agreement, contact your financial institution or contact xxx.xxxxxx.xx Signature of Account Holder Date You have certain recourse rights if any debit does not comply with this agreement. To obtain more information on your recourse rights, contact your financial institution or visit xxx.xxxxxx.xx.
Appears in 1 contract
Samples: pikelake.com
HOW WILL YOU BE PAYING. ❑ Credit Card on File ❑ Employee will call for Credit Card no. ❑ Cheque (dropped at office) ❑ Debit (at Office) Office Use Transaction No.: Received by: Staying at Pike Lake for 100 days or greater in any season. ❑ YES Fee of $500.00 +HST (Invoiced June 15th every year) 2022 2023 PRE-AUTHORIZED DEBIT AGREEMENT FORM ACCOUNT HOLDER INFORMATION BANK ACCOUNT INFORMATION Name: ❑ Void cheque already on file Address: or ❑ Will email new void cheque to xxxxxx@xxxxxxxx.xxx ❑ Will email form from bank to xxxxxx@xxxxxxxx.xxx City/Prov. Postal Code: You, the Payor, authorize Pike Lake Golf Centre Limited to debit the bank account identified above for the fixed amount of $324.87 348.41 on the 15th of every month for 12 consecutive months beginning Sept. 15, 2021 2022 to and including Aug. 15, 20222023. The office must be contacted 10 days prior to a payment date for any banking account changes. Any returned payment will result in a $75.00 NSF Charge + applicable taxes. You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of no less than 15 days. To obtain a sample cancellation form or for more information on your right to cancel a Pre-Authorized Debit Agreement, contact your financial institution or contact xxx.xxxxxx.xx Signature of Account Holder Date You have certain recourse rights if any debit does not comply with this agreement. To obtain more information on your recourse rights, contact your financial institution or visit xxx.xxxxxx.xx.. The Owner may, upon written notice to Occupant, in its absolute discretion terminate/cancel this agreement as a result of:
Appears in 1 contract
Samples: pikelake.com
HOW WILL YOU BE PAYING. ❑ Credit Card on File ❑ Employee will call for Credit Card no. ❑ Cheque (dropped at office) ❑ Debit (at Office) Office Use Transaction No.: Received by: Staying at Pike Lake for 100 days or greater in any season. ❑ YES Fee of $500.00 +HST (Invoiced June 15th every year) 2022 2023 PRE-AUTHORIZED DEBIT AGREEMENT FORM ACCOUNT HOLDER INFORMATION BANK ACCOUNT INFORMATION Name: ❑ Void cheque already on file Address: or ❑ Will email new void cheque to xxxxxx@xxxxxxxx.xxx ❑ Will email form from bank to xxxxxx@xxxxxxxx.xxx City/Prov. Postal Code: You, the Payor, authorize Pike Lake Golf Centre Limited River Place Campground Ltd. to debit the bank account identified above for the fixed amount of $324.87 279.20 on the 15th of every month for 12 consecutive months beginning Sept. 15, 2021 2022 to and including Aug. 15, 20222023. The office must be contacted 10 days prior to a payment date for any banking account changes. Any returned payment will result in a $75.00 NSF Charge + applicable taxes. You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of no less than 15 days. To obtain a sample cancellation form or for more information on your right to cancel a Pre-Authorized Debit Agreement, contact your financial institution or contact xxx.xxxxxx.xx Signature of Account Holder Date You have certain recourse rights if any debit does not comply with this agreement. To obtain more information on your recourse rights, contact your financial institution or visit xxx.xxxxxx.xx.. The Owner may, upon written notice to Occupant, in its absolute discretion terminate/cancel this agreement as a result of:
Appears in 1 contract
Samples: riverplacecampground.com
HOW WILL YOU BE PAYING. ❑ Credit Card on File ❑ Employee will call for Credit Card no. ❑ Cheque (dropped at office) ❑ Debit (at Office) Office Use Transaction No.: Received by: Staying at Pike Lake for 100 days or greater in any season. ❑ YES Fee of $500.00 +HST (Invoiced June 15th every year15, 2021) 2022 2021 PRE-AUTHORIZED DEBIT AGREEMENT FORM ACCOUNT HOLDER INFORMATION BANK ACCOUNT INFORMATION Name: ❑ Void cheque already on file Address: or ❑ Will email new void cheque to xxxxxx@xxxxxxxx.xxx ❑ Will email form from bank to xxxxxx@xxxxxxxx.xxx City/Prov. Postal Code: You, the Payor, authorize Pike Lake Golf Centre Limited to debit the bank account identified above for the fixed amount of $324.87 315.47 on the 15th of every month for 12 consecutive months beginning Sept. 15, 2021 2020 to and including Aug. 15, 20222021. The office must be contacted 10 days prior to a payment date for any banking account changes. Any returned payment will result in a $75.00 NSF Charge + applicable taxes. You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of no less than 15 days. To obtain a sample cancellation form or for more information on your right to cancel a Pre-Authorized Debit Agreement, contact your financial institution or contact xxx.xxxxxx.xx Signature of Account Holder Date You have certain recourse rights if any debit does not comply with this agreement. To obtain more information on your recourse rights, contact your financial institution or visit xxx.xxxxxx.xx.
Appears in 1 contract
Samples: pikelake.com