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    Pre-Authorized Debit Agreement (2)

    Uploaded by

    wikkawrapbeats

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Pre-Authorized Debit Agreement (2)

    Uploaded by

    wikkawrapbeats
    1 views1 page

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views1 page

    Pre-Authorized Debit Agreement (2)

    Uploaded by

    wikkawrapbeats

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    PRE-AUTHORIZED DEBIT (PAD) AGREEMENT

    QMC can arrange for your monthly utility bill to be paid automatically through Pre-Authorized Debit (PAD) from your
    bank account.
    Regular monthly payments for the full amount of services delivered will be debited to your specified account each month.
    QMC will provide 10 days written notice of the amount of each regular debit. QMC will obtain your authorization for any
    other one-time or sporadic debits. Your Pre-Authorized Debit will be processed on the due date, as indicated on your
    bill.
    You have certain recourse rights if any debit does not comply with this agreement. Additionally, you have the right to
    receive reimbursement for any PAD that is not authorized or is not in compliance with this agreement. To obtain
    more information on your recourse rights, contact your financial institution or visit www.cdnpay.ca. Your Payor’s PAD
    agreement may be cancelled provided notice is received at least 10 days prior to the next scheduled PAD.
    All persons authorized to sign on the account must agree to the terms of the PAD as indicated by their signatures below.
    To authorize this service please complete the following form and submit it, along with a blank cheque marked “VOID”', to
    QMC at:
    QMC
    Billing Department
    1105 – 573 Sherling Place
    Port Coquitlam, BC, V3B 0J6
    I/We hereby authorize QMC and the financial institution designated below to make deductions from the account shown
    below for monthly regular recurring payments and/or one-time payments from time to time as per my/our instructions,
    for payment of all charges arising under my/our QMC account(s)
    I/We hereby authorize QMC to draw the amount of the security deposit as required (approximately 2 ½ times your
    monthly billing. This amount will precede any amounts required for the monthly payment.

    Resident Name

    Resident Address

    City Province Postal code

    Financial Institution

    Branch# Account#

    Bank Address

    City Province Postal code


    Type Of Account: □ Chequing □ Savings □ Other Type Of Service: □ Business □ Personal

    Signature Date

    Signature Date

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