WATERLOO NORTH HYDRO INC. – 526 COUNTRY SQUIRE RD, WATERLOO, ON, N2J 4G8
1
Equal Payment Plan Application
I/we authorize Waterloo North Hydro Inc. (WNH), and the financial institution designated (or any
other
financial
institution I/We may authorize at any time) to begin deductions for payment of all charges
arising
under my/our WNH
account (s). Equal monthly payments for the budgeted amount will be debited
to
my/our account (s) beginning on the
due date of regular billings. WNH will provide written notice of
the
amount and timing of each regular debit. WNH will
obtain my/our authorization for any other one-time
or
sporadic
debits.
This authority is to remain in effect until WNHI
has received written notification from me/us of its
change
or termination. This notification must be received at least 10
business days before the next debit
is
scheduled at the address provided below. I/We may obtain a sample cancellation
form, or
more
information on my/our right to cancel a PAD agreement at my/our financial institution or by
visiting
www.cdnpay.ca.
WNHI may not assign this authorization, whether directly or indirectly, by operation of law, change
of
control or
otherwise, without providing at least 10 days prior written notice to
me/us.
I/We have certain recourse rights if any debit does not comply with this agreement. For example,
I/We
have the right to
receive reimbursement for any PAD that is not authorized or is not consistent with
this
PAD agreement. To obtain a form
for a Reimbursement Claim, or for more information on
my/our
recourse rights, I/We may contact my/our financial
institution or visit www.cdnpay.ca.
Hydro
Account
Number
_______________
- ______________________
_____________
Type
of
Service:
Residential
Business
Name
on
Hydro
Bill
________________________________________________________________________________
Address
_____________________________________________________
Home
Phone
_______________
City__________________ Work
Phone
_
_____________________
Ext
________
Province
_______________
Postal
Code
________________________________
Email
Address
_____________________________________________________________________
Financial
Institution
(FI):
_____________________________
Account
________________________________
Transit Number
____________ - ____
( branch-5 digits, institution-3
digits)
Name on enclosed cheque _______________________________________________________________________________
Signature
1)
_______________
Date
Signature 2) _______________ Date ________
(if joint account, both parties must
sign)
Please enclose a cheque marked
‘VOID.’
Please note, the form must be signed by the signing authority for the account.
Mail to: Waterloo North Hydro Inc., 526 Country Squire Rd., Waterloo, ON; N2J 4G8 Fax: (519)
746-0133
Email: customersupport@wnhydro.com Website: www.wnhydro.com
Waterloo North Hydro Inc. uses the information we collect on this form to facilitate
pre-authorized
payment for services.
We are committed to protecting the privacy of your personal information and
we
have developed policies and procedures
in compliance with the Personal Information Protection
and
Electronic Documents
Act.
