MMM PAD Authorization Form. .pdf
Original filename: MMM-PAD-Authorization-Form..pdf
This PDF 1.6 document has been generated by Microsoft® Word 2010 / Mac OS X 10.11.2 Quartz PDFContext, and has been sent on pdf-archive.com on 01/06/2016 at 06:25, from IP address 69.157.x.x.
The current document download page has been viewed 235 times.
File size: 515 KB (1 page).
Privacy: public file
Download original PDF file
Pre‐Authorized Payment Form
1. Customer Information (Please Print Clearly)
MaxiMind Montessori Account No.
2. Bank Account Information
Deposit Account Number:
Financial Institution Number:
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)
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: email@example.com Web: www.maximindmontessori.com
2637 Eglinton Avenue East # 2, Toronto, Ontario M1K 2S2 Tel: (416) 912-4885