PRE-AUTHORIZED DEBIT (PAD) AGREEMENT

PRE-AUTHORIZED DEBIT (PAD) AGREEMENT
Unionville Alliance Church

4898 Sixteenth Avenue, Markham, ON L3R 0K6

Telephone: 905-477-1104

Email: accounting@uachome.org

Web: www.uachome.org
Payor's Information:
Giving # (if known)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Payor's Financial Institution Information:
Name of Financial Institution
Account Number
Transit Number
Financial institution Number
Please upload a voided cheque or a Bank Direct Deposit form:

You can also email to accounting@uachome.org or bring a copy to the office
Cancelof
Deposit form PAD Details:
You, the Payor, authorize Unionville Alliance Church to debit the bank account identified above as per your instructions below, and you, the Payor, confirm that you have authority under the terms of your account agreement to authorize this debit.

Weekly transaction: Bi-weekly transaction: Monthly transactions:
Pick one of the following frequencies:

Weekly Transaction: Every MondayBi-weekly Transaction: EVery Other MondayMonthly Transaction: 15th of the monthMonthly Transaction: Last day of the month
Specify Fund designation:
Operating (General) Fund
Supports our church’s essential activities and services
Missions Fund
fuels our global and local missions partnerships
Community Care Fund
aids local initiatives like Master's Pantry, Hampers of Hope, Grief Care, and support for those in need
Capital or Building Improvement Fund
ensures the maintenance and improvement of our church facilities
TOTAL:
Effective Agreement Date

DayMonthYear
Date
Old Agreement Date (if applicable)

DayMonthYear
Date
This Donation is for

Personal UseBusiness Use
Account Holder Name (Payor)
Signature of Account Holder (Payor)

Clear
Upload Signature of Account Holder (Payor)

If you can't sign the above and need to upload as an image
Cancelof
Joint Account Holder Name (if applicable)
Signature of Joint Account Holder (if applicable)

Clear
Upload Signature of Joint Account Holder (if applicable)

If you can't sign the above and need to upload as an image
Cancelof
Date Signed

DayMonthYear
Date
How to Revise or Cancel Agreement

You may revoke your authorization at any time, subject to providing notice in writing of 10 (ten) business days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD agreement, you may contact your financial institution or visit www.payments.ca. This authority is to remain in effect until Unionville Alliance Church has received written notification from you of its change or termination. To change either the transaction date, amount, or bank account changes, simply send us a letter or email to accounting@uachome.org indicating the changes requested. If for any reason you wish to cancel the plan at any time, simply send us a letter or email stating this request at least 10 (ten) business days before the next scheduled debit. You have certain recourse rights if any debit does not comply with this Agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with the PAD Agreement. To obtain more info on your recourse rights, you may contact your financial institution or visit www.payments.ca.
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PRE-AUTHORIZED DEBIT (PAD) AGREEMENT

Unionville Alliance Church

Payor's Information:

Payor's Financial Institution Information:

Deposit form PAD Details:

Specify Fund designation: