Pre-Authorized Payment AgreementPre-Authorized Payment Agreement • October 22nd, 2018
Main Contact First Name Last Name Birthdate (DD/MM/YY) Gender (Circle) Male / Female / X Not Specified Residency Information Street Address City Postal Code Home Telephone Cellular Telephone Business Telephone Email Address Family Information (Family/Group Memberships Only) Name (Incl. last if different from above) Gender Birthdate (DD/MM/YY) 1. 2. 3. 4. 5. Emergency Contact Information Full Name Relationship Phone Number Payment Authorization Account Holder First Name Account Holder Last Name Account Holder Address (If different from above) Payment Type: Visa Mastercard American Express Bank Account (Attach Account Info/Void Cheque)Last 4 Digits of Card: Expiry: / Payment Date: 1st of the month 15th of the month Monthly Payment Amount $ GST (if applicable) $ Total $
ContractPre-Authorized Payment Agreement • September 22nd, 2021
Customer Status*:Owner Tenant Account Number*: Service Address*: (Street Number, Street Name, Unit Number) City*: Postal Code*: Electrical Vehicle Parking Unit No. (if any) Account Holder*: First Name*: Middle Name: Last Name*: Mailing Address*: (Street Number, Street Name, Unit Number) City*: Postal Code*:
PROPERTY TAXPre-Authorized Payment Agreement • March 17th, 2020
I/We (the above named customer) authorize the Municipality of Chatham-Kent to debit my/our account on the due date, or if monthly plan, on the 15th day of the month.
Pre-Authorized Payment (PPP) AgreementPre-Authorized Payment Agreement • July 31st, 2009
PRE-AUTHORIZED PAYMENT AGREEMENT FOR PROPERTY TAX ACCOUNTSPre-Authorized Payment Agreement • July 6th, 2022
WHAT IS A PRE-AUTHORIZED PAYMENT?Pre-Authorized Payment Agreement • October 26th, 2009
You may sign an agreement allowing a company to take money out of your account to pay a bill on a monthly or annual basis. This agreement authorizes the company to process a debit against your account. For example, if you enter into a pre-authorized payment arrangement with your phone company, the phone company would take the money out of your account each month to pay your phone bill.
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • August 8th, 2022
Name: Last First Middle NSCN Registration Number: Mailing Address: Apt/Box No. Number Street City/Town Province Postal Code Telephone: Email: Category of Registration: Licensed Practical Nurse Registered Nurse Nurse Practitioner
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • December 4th, 2019
This authorization will continue until such time as the project you are supporting concludes, or Global Youth Volunteer Network receives written notice from you to discontinue future payments.Written notice must be received THIRTY (30) days prior to the date of withdrawal.
CORPORATION OF THE TOWN OF KINGSVILLEPre-Authorized Payment Agreement • August 31st, 2015
PRE-AUTHORIZED PAYMENT AGREEMENT (PPA)Pre-Authorized Payment Agreement • June 13th, 2023
In order to take advantage of the Pre-Authorized Payment plan offered by Groupe Maskatel LP, please fill-out the following Pre-Authorized Payment Agreement.
Pre-Authorized Payment (PAP) AgreementPre-Authorized Payment Agreement • December 15th, 2014
WHAT IS A PRE-AUTHORIZED PAYMENT?Pre-Authorized Payment Agreement • May 17th, 2011
You may sign an agreement allowing a company to take money out of your account to pay a bill on a monthly or annual basis. This agreement authorizes the company to process a debit against your account. For example, if you enter into a pre-authorized payment arrangement with your phone company, the phone company would take the money out of your account each month to pay your phone bill.
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • March 27th, 2013
CLEAR FIELDSPre-Authorized Payment Agreement • January 27th, 2009
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • February 4th, 2024
The following pre-authorized payment agreement must be completed by the primary Metergy Solutions Inc. account holder.
NOTE: THIS PLAN DOES NOT COVER SUPPLMENTARY TAX BILLINGS ALL ARREARS MUST BE PAID IN FULL PRIOR TO IMPLEMENTATIONPre-Authorized Payment Agreement • April 28th, 2022
Note: If you own multiple properties you must complete a separate form for each property you would like included in the pre-authorized payment plan. Three PAP payments returned from the bank in a consecutive year will result in removal from the pre-authorized payment program.
Please complete and return this form to the Billing Department by mail or email.Pre-Authorized Payment Agreement • July 27th, 2020
The following pre-authorized payment agreement must be completed by the primary Enercare Home Services account holder.
Pre-authorized Payment AgreementPre-Authorized Payment Agreement • May 25th, 2018
Alta Newspaper Group LP Pre Authorized Payment AgreementPre Authorized Payment Agreement • February 7th, 2018
This authorization is provided for the benefit of the Payee and our Financial Institution and is provided in consideration of our Financial Institution agreeing to process our account in accordance with the rules of Canadian Payments Association (the “CPA”).
I/We authorize Blendable Inc, and the financial institution designated (or any other financial institution I/we may authorize at any time) to begin deductions as per my/our instructions for regular recurring payments and/or one-time payments from time...Pre-Authorized Payment Agreement • January 13th, 2021
This authority is to remain in effect until Blendable Inc has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAP Agreement at my/our financial institution by visiting www.cdnpay.ca.
Windsor Essex CHCPre-Authorized Payment Agreement • January 22nd, 2016
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • April 26th, 2022
The above noted person hereby authorizes Ottawa-Carleton-Standard Condominium Corporation No. 803 to draw upon the account indicated below for the purpose of common charge payments due on the 1st day of each month and payment for smoke detector replacements when required by the annual fire inspection. Please attach a void cheque below.
PRE-AUTHORIZED PAYMENT AGREEMENT FORMPre-Authorized Payment Agreement • October 30th, 2019
As the credit card holder, I authorize NuIMPACT Corp. to use the credit card for purchases shipped to an address other than the above.
PRE-AUTHORIZED TAX/UTILTIY PAYMENT PLAN AUTHORIZATION AGREEMENTPre-Authorized Payment Agreement • September 7th, 2022
I/we, the undersigned, hereby authorize The Municipality of Southwest Middlesex and the financial institution identified below (or any other financial institution I/we may authorize at any time) to draw monthly payments from the account (identified below) payable to The Municipality of Southwest Middlesex for payment of utilities, property taxes and amounts added to the tax roll.
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • July 3rd, 2019
Instructions: Complete and return this form to Saskatchewan Blue Cross by mail, fax (306.652.5751) or online at sk.bluecross.ca/contactus.
AGREEMENT FOR PRE-AUTHORIZED PAYMENTSPre-Authorized Payment Agreement • October 23rd, 2015
EZ PayPre-Authorized Payment Agreement • March 15th, 2017
Pre-Authorized Payment (PAP) Agreement SET UP Account Holder Name: on behalf of ( ) - First Name and Last Name (if different from above) Telephone Number - , Unit # Street # Street Name City in Ontario Tenant IDThis payment is made on behalf of: an Individual a Business EZ Pay - Pre-Authorized Payment (PAP/PAD) Agreement I/We authorize CityHousing Hamilton Corporation to debit the attached bank account on the first (1) day of every month commencing the first of , 20_ for regular recurring payments as agreed to in my/our lease with CityHousing Hamilton. The amount of the PAP/PAD will be equivalent to the monthly charge as per the current leasing agreement and may change periodically. This could mean that if your subsidy is removed for any reason, the PAP/PAD amount withdrawn from your account will be the current market rent amount for your unit. This PAP/PAD agreement only applies to the method of payment and any termination of the agreement does not have any affect whatsoever with res
CORPORATION OF THE TOWN OF KINGSVILLEPre-Authorized Payment Agreement • April 7th, 2015
PRE-AUTHORIZED PAYMENT AGREEMENTPre-Authorized Payment Agreement • February 13th, 2019
Please complete this form and return it to the Tax Administrator at the Chippewas of Georgina Island Band Office together with either a VOID Cheque or with your banking information from your financial institution. You can return this form by mail, fax, email (Stephanie.bigcanoe@georginaisland.com) or in person.
AGREEMENT FOR PRE-AUTHORIZED PAYMENTSPre-Authorized Payment Agreement • February 11th, 2016
AGREEMENT FOR PRE-AUTHORIZED PAYMENTSPre-Authorized Payment Agreement • April 1st, 2017
My/Our account to be credited at VanCity is Account Number Branch Number Account to be debited is at:Pre-Authorized Payment Agreement • October 28th, 1999
ContractPre-Authorized Payment Agreement • May 26th, 2016
Pre-Authorized Payment Agreement Participant (Henceforth called “Payer”): Pre-Authorized with bank Pre-Authorized with credit cardBank/Credit Union (henceforth called "Financial Institution"): Name on the card (Henceforth called "Account"):Account Number (Henceforth called "Account"): Credit card number (henceforth called "Credit card"): Transit: Institution: _ Expiry date: _/_ (99999) (999)(Please enclose a copy or a cancelled cheque)
Pre-Authorized Payment PlansPre-Authorized Payment Agreement • November 23rd, 2023
Complete the Pre-Authorized Payment Application form. Forms can be obtained at Township office or from our website, sables-spanish.ca. Attach a “VOID” cheque or customer account information provided by a financial institution to the completed application and submit them to the Township of Sables-Spanish Rivers at least fifteen (15) business days prior to the start date.
AGREEMENT FOR PRE-AUTHORIZED PAYMENTSPre-Authorized Payment Agreement • May 15th, 2014
