Pre-Authorized Payment Plan Agreement Sample Contracts

PRE-AUTHORIZED PAYMENT PLAN (PAP) AGREEMENT
Pre-Authorized Payment Plan Agreement • March 1st, 2016

I/We hereby authorize the Town of Wasaga Beach and the designated financial institution to begin deductions following the Plan selected below. In addition, I/we acknowledge that there will be a $35.00 service charge for a pre-authorized payment that is refused by my financial institution, and should there be any change to my address or banking information, it is my responsibility to provide written notice to the Treasury Department.

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THE CORPORATION OF THE TOWNSHIP OF WILMOT
Pre-Authorized Payment Plan Agreement • November 19th, 2015
Authorization Agreement
Pre-Authorized Payment Plan Agreement • March 6th, 2017
Contract
Pre-Authorized Payment Plan Agreement • October 16th, 2012

First Name: Last Name: CRPNM Registration # Address: City: PostalCode: Telephone: Email: YES I want to participate in the Pre-authorized Payment Plan I am a New EnrolleeI am already enrolled and I am reporting changes to my Banking Information I wish to add $ to my monthly payment in support of the Registered Psychiatric Nurses Foundation (RPNF) I have enclosed a VOID cheque. I understand the following conditions apply: 1. This agreement is in perpetuity;2. A request for removal from the Pre-authorized Payment Plan must be submitted to the CRPNM in writing;3. Any Pre-authorized debits that are refused by my bank will be subject to a $50.00 service fee;4. That 2 NSF occurrences during the plan period will result in cancellation of my participation in the plan;5. That it is my responsibility to promptly notify the CRPNM of any changes to my banking information. Signature: Date:

Parks, Recreation & Culture Department Pre-Authorized Payment Plan Agreement Form
Pre-Authorized Payment Plan Agreement • May 11th, 2021

• Valid credit card (Visa, MasterCard, or American Express) which does NOT expire within the next three months of application completion

PRE-AUTHORIZED PAYMENT PLAN AGREEMENT PROPERTY TAX AND WATER/WASTEWATER
Pre-Authorized Payment Plan Agreement • November 27th, 2019

PROPERTY TAXES PAYMENT OPTIONS MONTHLY PLAN12 Months (January – December) day of each month INSTALLMENT PLAN4 withdrawals per year February 28, April 30July 31, September 30 BI-WEEKLY PLAN26 Bi-weekly payments Beginning date:

Pre-Authorized Payment (PAP) Plan Agreement
Pre-Authorized Payment Plan Agreement • June 29th, 2015
Pre-Authorized Payment Plan Agreement For Condominium Monthly Common Charges
Pre-Authorized Payment Plan Agreement • March 14th, 2016
TSCC 2210
Pre-Authorized Payment Plan Agreement • May 19th, 2015
Contract
Pre-Authorized Payment Plan Agreement • November 2nd, 2018

Pre-Authorized Payment Plan Agreement P.O BOX 20, Wasaga Beach, ON, L9Z 1A2 Phone: (705) 429 - 2517 Fax: (705) 429-2590 E-mail: hydro@wasagadist.ca Website: www.wasagadist.ca Please complete the Pre-Authorized Debit (PAD) agreement below. I/we authorize Wasaga Distribution 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 monthly payments and/or one-time payments from time to time, for payment of all charges arising under my/our Wasaga Distribution Inc. account(s). Regular payments for the full amount of services delivered will be debited to my/our specified account on the day agreed upon with Wasaga Distribution Inc. Wasaga Distribution Inc. will provide 10 days written notice of the amount of each regular debit. Wasaga Distribution Inc. will obtain my/our authorization for any other one-time or sporadic debits. For business account customers, your signatures(

Contract
Pre-Authorized Payment Plan Agreement • December 4th, 2020

The Pre-Authorized Payment option enables your bill payment to be withdrawn directly from your account. The withdrawal is made on the due date indicated on your statement.

Authorization Agreement
Pre-Authorized Payment Plan Agreement • April 16th, 2019

I/We, the undersigned, hereby authorize the financial institution (identified below) to draw payments from the account (identified below) payable to the Municipality of Wawa for payment of municipal property taxes and/or water & sewer services.

PRE-AUTHORIZED PAYMENT PLAN (PAP) AGREEMENT
Pre-Authorized Payment Plan Agreement • August 24th, 2016

I/We hereby authorize the Town of Wasaga Beach and the designated financial institution to begin deductions as per the Plan selected below. In addition, I/we acknowledge that there will be a

PRE-AUTHORIZED PROPERTY TAX & WATER & WASTEWATER PAYMENT PLAN AGREEMENT
Pre-Authorized Payment Plan Agreement • January 28th, 2016
Pre-authorized Payment Plan Agreement
Pre-Authorized Payment Plan Agreement • June 9th, 2008

I/We hereby authorize the City of Victoria and the financial institution designated to debit my bank account indicated for the charges arising under my City of Victoria utility account. The payment for services will be debited on the due date specified on the invoice provided.

Pre-Authorized Payment Plan Agreement
Pre-Authorized Payment Plan Agreement • December 15th, 2015
Pre-authorized Payment Plan Agreement – Heat Pump Rental
Pre-Authorized Payment Plan Agreement • May 27th, 2020
Parks, Recreation & Culture Department Pre-Authorized Payment Plan Agreement Form
Pre-Authorized Payment Plan Agreement • December 5th, 2013

• Valid credit card (Visa, MasterCard, or American Express) which does NOT expire within the next three months of application completion

Pre-Authorized Payment Plan Application Form
Pre-Authorized Payment Plan Agreement • August 26th, 2020

This is a convenient service that helps you avoid standing in line, writing monthly cheques or paying for postage by authorizing automatic monthly payment of your utility bill from your bank account. This program is voluntary and you may opt out of the pre- authorized payment plan at any time.

BOARDING: PRE-AUTHORIZED PAYMENT PLAN AGREEMENT
Pre-Authorized Payment Plan Agreement • January 22nd, 2024

If you have selected the Pre-authorized Payment Plan option above for payment of Tuition Fees or the Student Accounts, please fill in and return this form to Ashbury College along with a blank cheque from your account that is unsigned and marked VOID (for banking purposes).

PRE-AUTHORIZED PAYMENT PLAN AGREEMENT
Pre-Authorized Payment Plan Agreement • August 12th, 2019

 Provide this agreement to the housing authority by the 10th of the month to start pre-authorized payments in the following month.

PRE-AUTHORIZED PAYMENT PLAN AGREEMENT FOR PAYMENT OF ANNUAL TAX LEVY
Pre-Authorized Payment Plan Agreement • February 4th, 2016

Tax Payers wishing to enroll in the pre-authorized payment plan for payment of their annual tax levy must adhere to the following:

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Pre-Authorized Payment Plan Agreement
Pre-Authorized Payment Plan Agreement • June 14th, 2013

This agreement can be terminated, with 2 weeks written notification, by either the customer or LARA Internet. Upon termination, any amount due shall be paid directly to LARA Internet.

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