Pre-Authorized Payment Form

Pre-Authorized Payment Form
Company Name
Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Credit Card Information
I authorize Connectability Inc. to debit my credit card with the amount due shown on my monthly Connectability invoice.
VISAMASTERCARDAMEX
Credit Card Number
Cardholder Name

First NameLast Name
CVV
Expiry Date
mm/yy
Pre-Authorized Debit (PAD) Agreement - ACH Payments
I authorize Connectability Inc. to debit my bank account (attach void cheque) for the amount due shown on my monthly Connectability invoice or statement.
PersonalBusiness
Financial Institution Number
Branch Transit Number
Account Number
Account Holder Name
Account Holder's Signature

Clear
Electronic Funds Transfer (EFT)
It is important that Connectability be notified when you make a payment, so we can apply it to the correct invoice and your account. When you process an EFT payment, you must send an email to lauriea@connectability.com and katem@connectability.com.
Should be Empty: