Payor's PAD Agreement

Payor

(The "Payor" is the person whose account will be debited for payment)

NWIC Account Number

(Your Account Number is available in your NWIC welcome package or attached to a recent invoice.)

Name*

First Last

Phone*

Email*

Address*

Street Address City Postal Code

Financial Institution

Financial Institution Name*

Address

Street Address

Account Information

Branch Transit Number*

Institution ID*

Account Number*

Authorization

I/We acknowledge that this agreement is provided for the benefit of the "Payee" and "Processing Institution" and is provided in consideration of the Processing Institution agreeing to process debits ("PADs") against the Account with the Processing Institution in accordance with the Rules of the Canadian Payments Association (the "CPA Rules").

By signing this agreement, I/we acknowledge having received a copy of this agreement, including the terms and conditions below, and I/we acknowledge having read and understood its contents. I/We agree to be bound by this agreement, including the terms and conditions below.

I/We warrant and guarantee that the person(s) whose signature(s) are required to sign on the Account have signed below.

Pre-Notification Waiver*

I/we waive any and all requirements for pre-notification of debiting, including, without limitation, pre-notification of any changes in the amount of the PAD due to a change in any applicable tax rate, top-up, or adjustment.

I agree

Hidden

Date

Signature of Account Holder*

Is there a joint account holder?

Yes

Signature of Joint Account Holder

Cancellation Information

Note: You may revoke this authorization at any time [Payee to insert process — e.g., "in writing or by phone"], subject to providing notice of [Payee to insert period — not to exceed 30 days]. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit www.cdnpay.ca.

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Payor’s PAD Agreement

Payor

Financial Institution

Account Information

Authorization

Cancellation Information

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