PRE-AUTHORIZED DEBIT ENROLMENT AGREEMENT

Name of account holder *

FirstLast

Condo #*

Main phone number (with an answering machine if possible)*

Area codePhone

Other phone number

Area codePhone

Email address*

example@example.com

REGULAR PAYMENTS: I authorize the financial institution of my Syndicate to make pre-authorized debits from my account, on a monthly interval, on the 1st of every month, or the next business day, for the following services (please check all that apply):

Regular condo feesParkingCableOther

Date of first withdrawal

MonthDayYear

Each withdrawal will correspond to a fixed amount, in concurrence to the annual budget, which the management firm will communicate to me, in writing, at least 10 days before the first withdrawal.

SPORADIC PAYMENTS: I also authorize the financial institution of my Syndicate to make sporadic pre-authorized debits from the account, from time to time, for the payment of (please check all that apply):

Special assessmentsRetroactive adjustmentsBalance owing (please specify the amount in the field below):Other

Each withdrawal will correspond to a variable amount, which the management firm will communicate to me, in wirting, at least 10 days before the first withdrawal.

TERMS AND CONDITIONS

CHANGE OR REVOCATION

I shall inform the management firm, in a timely manner, of any change to this agreement.

IMPORTANT: If you change your bank account or financial institution, please advise us accordingly.

I retain the right to revoke my authorization at any time, with a notification of 10 days, prior to the next pre-authorized payment withdrawal. I agree to release the financial institution and the management firm of any liability if the revocation is not respected, except in the case of gross negligence on their part. I agree that the financial institution at which I maintain the account is not required to verify that the payment is debited in accordance with this agreement. I also certify that every person whose signature is required fot the operation of the bank account below has authorized this agreement. I acknowledge that the delivery of this authorization to the Payee constitutes delivery by me to my financial institution.

REIMBURSEMENT

I have the right to receive reimbursement, by way of cheque, for any debit that is not authorized or that is not compatible with the terms of this agreement.

CONSENT TO DISCLOSURE OF INFORMATION

hereby consent to the disclosure of the information contained in my pre-authorized debit enrolment to the financial institution, provided such information is directly related to and required for the smooth application of the rules governing pre-authorized debits.

Initials*

IMPORTANT

Attach the image a personal cheque marked "VOID"

Upload the cheque image