Authorization for Personal Pre-Authorized Debit (PAD) Service
Instructions:
1. Please complete all sections in order to make payments to your MBNA credit card
account(s) directly from your personal chequing account.
2. Please read the Authorization terms and sign this form.
3. Please return the completed form with a blank cheque marked “VOID” to either our
toll-free fax number or the address below:
MBNA
P.O. Box 9625 STN T
Ottawa, Ontario K1G 9Z9
Toll-free Fax: 1-800-871-0994
4. If you have any questions, please call our Customer Service line, toll-free,
at 1-800- 347-6262; 24-hours a day, seven days a week.
To change your account information, you must complete a new Authorization
and submit a new “VOID” cheque. Please allow 10 days for us to complete your
request. If you want to cancel or change the amount of a pending payment, please
call our toll-free Customer Service number. You have certain recourse rights if any
debit does not comply with this Authorization. For example, you have the right
to receive reimbursement for any debit that is not authorized or is not consistent
with this Authorization. You may revoke your Authorization at any time, subject
to providing notice of 30 days to MBNA. To obtain a sample cancellation form,
or for more information on your right to cancel a PAD Agreement, contact your
nancial institution or visit www.cdnpay.ca.
You can select up to 3 MBNA Accounts – Please enter your 16 or 14 digit account number(s)
Further details regarding payment options can be found on the reverse.
Payment
Options
Total Minimum Payment Due
New Balance Total/Grace Period Payment Amount
Fixed Amount:
*
**
Payment
Options
Total Minimum Payment Due
New Balance Total/Grace Period Payment Amount
*
Fixed Amount:
**
Payment
Options
Total Minimum Payment Due
New Balance Total/Grace Period Payment Amount
Fixed Amount:
*
**
Customer’s Information
Name:
Home Address:
Home Telephone Number:
Customer’s Personal Chequing Account Information (please include a “VOID” cheque)
Account Number:
Branch Transit Number (5 digits):
Branch Institution Number (3 digits):
Financial Institution Name:
Financial Institution Address:
Authorization
I/We, the chequing account holder(s) signing below, authorize The Toronto-Dominion Bank in regard to your MBNA account to debit my/our chequing account, referenced above, for the
purpose of paying the MBNA account(s) dened above. The debits may be processed at such times and in such amounts as I/we may authorize. I/ We warrant and guarantee that I/we have
provided MBNA with all relevant information in respect to my/our chequing account and that all persons required to sign on the chequing account have signed this Authorization. I/We agree
to waive all pre-notication requirements. I/We agree that if any debit authorized under this Authorization is returned unprocessed or is rejected for any reason, MBNA may re-present the debit
for Authorization and may initiate another debit in the amount of its returned payment fee as set out in the account agreement that applies to my/our MBNA account. I/We agree that if MBNA
sells, assigns or transfers my MBNA account, this Authorization may be assigned to the person or entity to whom my MBNA account is sold, assigned or transferred. MBNA is a division of
The Toronto-Dominion Bank.
Signature of Chequing Account Holder:
Name (please print):
Date:
Signature of Joint Account Holder:
Name (please print):
Date:
click to sign
signature
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