Genesis (Preschool) PAD Form

BRANT CHRISTIAN SCHOOL SOCIETY

Pre-Authorized Debit Agreement (PAD)
Box 130 Brant, AB T0L 0L0 Ph: (403) 684-3752 Fax: (403) 684-3894 Website: www.brantchristianschool.com
I/We authorize Brant Christian School Society (BCSS) 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 regular recurring payments, and/or one –time payments from time to time, for payment of all charges arising under my/our BCSS account. Regular monthly payments for the full amount of services obtained will be debited to my/our specified account on the 1 day of each month. BCSS will provide 10 days written notice and obtain authorization for any one-time or sporadic debits.
This authority is to remain in effect for one year or until BCSS 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 PAD Agreement at my/our financial institution or by visiting www.cdnpay.ca
BCSS may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us.
I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/We have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain a form for Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution or visit www.cdnpay.ca
Name

First NameLast Name
Email
example@example.com
Joint Name (if app)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Type of Account
Name of Bank
Address Of Bank

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FI Transit Number: (branch- 5 digits)
FI Intitution number 3 digits
FI Account Number
Signature

Clear
Signature Of Joint Account Holder (if app)

Clear
Date

MonthDayYear
Date
Total amount applying for PAD:
Important note: deductions will be made for 9 months (September - May). The deposit (first month fee) that was paid on registration will be deducted from the overall total owing.
Should be Empty:

BRANT CHRISTIAN SCHOOL SOCIETY