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MMM PAD Authorization Form. .pdf


Original filename: MMM-PAD-Authorization-Form..pdf
Author: Online2PDF.com

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Pre‐Authorized Payment Form
1. Customer Information (Please Print Clearly)
Name:
MaxiMind Montessori Account No.
Street Address:
City:

Province:

Postal Code:

Phone Number:

Work:

2. Bank Account Information
Branch Transit

Deposit Account Number:

Number:
Financial Institution Number:
Financial Institution:

Chequing Account

Savings Account

Name:
Branch Address:

3. Pre‐Authorization Debit (PAD) Details
You, the Payor, authorize MaxiMind Montessori School to debit the bank account identified above for $ tuition fee on
the enrollment date of every month or the next business day.
I/we authorize MaxiMind Montessori School and the financial institution designated (or any other financial institution I/
we may authorize at any time) to begin deductions as per our instructions for monthly regular recurring payments and/or
one-time payments from time to time, for payment of all charges arising under our MaxiMind Montessori School
account(s). Regular monthly payments for the full amount of services delivered will be debited to our specified account on
the 1st day of each month.
This authority is to remain in effect until MaxiMind Montessori School has received written notification from us of its
charge or termination. This notification must be received within 30 days before the next debit is scheduled at the address
provided below. I/we can obtain more information on my/our right to cancel a PAD Agreement at my/our financial
institution or by visiting www.cdnpay.ca.

Signature of Account Holder:

Signature of Joint Account Holder (if applicable)

Name:

Name:

(Please print)

(Please print)

Date:

Date:
MaxiMind Montessori School may not assign this authorization, whether directly or indirectly, by operation of
law, change or control or otherwise, without providing at least 30 days prior written notice to us.

When the form is complete, submit to school administration along with a cheque from the above
account. Cross cheque and mark it “VOID”. (for assistance please speak with the school administration)
Email: info@maximindmontessori.com Web: www.maximindmontessori.com
2637 Eglinton Avenue East # 2, Toronto, Ontario M1K 2S2 Tel: (416) 912-4885


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