2026-2027 NYAC Pre-Authorized Debit (PAD) Agreement

2026-2027 NYAC Pre-Authorized Debit (PAD) Agreement

NYAC Pre-Authorized Debit (PAD) Agreement

2026-2027 Season
Name of Account Holder

First NameLast Name
How many swimmers are you registering?
Name of Swimmer #1

First NameLast Name
Name of Swimmer #1

First NameLast Name
Name of Swimmer #2 (if applicable)

First NameLast Name
Name of Swimmer #3 (if applicable)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com

We require you to fill out the information below and also attach the bank information/void cheque so we can double check the numbers upon processing.
Please upload a void cheque OR your account details from your bank institution. The upload should have all the information shown like in the picture below.

Cancelof
Name of Financial Institution (ex: TD Canada Trust, Simplii Financial)
Transit #
Institution #
Account #

Signature of Account Holder
Signature of Joint Account Holder (if applicable)
Should be Empty: