Fill - Free fillable Pre-Authorized Debit (PAD) Agreement FOR INTERNAL USE ONLY PDF form

M6893-2/15

Pre-Authorized Debit (“PAD”) Agreement

In this Agreement, which includes the terms and conditions on the reverse, all references to “I/we”, “me/us”, and “my/our” means

the account holder listed below, and all references to “you” and “your” means Vertica Resident Services Inc. Where the context

warrants, references to you and your means or includes the owner of the building managed by Vertica Resident Services Inc. in which

my/our premises are leased.

I/We hereby authorize you to withdraw monthly recurring lease payments from my/our Account in the Monthly Fixed Withdrawal

Amount set out below, and in accordance with this Agreement. I/we and you waive any requirement for you to notify me/us of

the Monthly Fixed Withdrawal Amount and the Payment Due Date before the due date of the first PAD.

I/We authorize my/our financial institution (which is also referred to in this Agreement as “F/I”) to honour payment withdrawals by you.

Conditions of PAD Agreement

Withdrawal day

My/Our PAD will not be withdrawn from my/our Account earlier than the payment due date set forth in

my/our Lease Agreement (the “Payment Due Date”).

Termination

My/Our PAD may be terminated if any withdrawal is rejected or reversed by my/our nancial institution.

Payment change

If my/our PAD amount changes because of an increase in base rent, property taxes or common area

costs, renewal of my/our lease at a different rate, or for any other reason, you will notify me/us in writing

at least 10 calendar days before the change becomes effective. Your letter will state the date on which

the amount of my/our PAD will change.

Change in ﬁnancial

institution

If I/we change my/our nancial institution, branch or account number, I/we must advise you in

writing delivered to the above address at least 20 days before my/our next Payment Due Date. I/we

acknowledge that failure to so notify you may result in my/our payment being dishonoured and my/our

lease being in default.

Insufﬁcient funds in

my/our Account

This Agreement authorizes you to charge a fee for any PADs not honoured by my/our nancial institution

due to insufcient funds in my/our account. If my/our nancial institution noties you that there are

insufcient funds in my/our Account, you will make a second attempt to withdraw my/our payment. By

signing this Agreement, I/we waive your requirement to notify me/us of any dishonoured payment.

Please complete the following:

Name of Account holder (please print as shown on record of nancial institution)

Name of nancial institution

Address of nancial institution City or Town Province

F/I Transit Number (5 digits) F/I Number (3 digits) F/I Account Number (the “Account”)

Please attach a void cheque Effective Date Monthly Fixed Withdrawal Amount

Type of PAD: Business Personal

Type of Account: Chequing Savings (Please note that payments cannot be withdrawn from a non-chequing savings account.)

I/We acknowledge that this PAD Agreement does not change the terms or conditions of my/our lease.

I/We have read and understood this Agreement, including the additional terms and conditions on the reverse which form a

part of this Agreement.

Signature(s) Date

Address Postal Code

Phone Number Fax Number

document without the express written consent of Vertica is strictly prohibited.

Vertica Resident Services Inc.,

FOR INTERNAL USE ONLY

Resident ID

Property

Number(s)

900-200 University Avenue Toronto ON M5H 3C6 Fax # 416.552.6111

Clear

Terms and Conditions

I/We acknowledge that this Agreement, is provided for the benefit of you and your financial institution and is provided in consideration

of my/our financial institution agreeing to process debits in paper, electronic or other form against my/our account in accordance with

the Rules of the Canadian Payments Association.

I/We warrant and guarantee that all persons whose signatures are required to sign on the Account have signed on the front of this

Agreement.

I/We hereby authorize you to debit my/our Account, for the following purpose: Payment of Recurring Lease Obligations.

This Agreement may be cancelled at any time upon written notice by me/us. I/We acknowledge that, in order to revoke this

Agreement, I/We must provide written notice to you delivered to your mailing address or fax number listed on the front of this

Agreement at least 20 days before my/our next Payment Due Date.

I/We may obtain a sample cancellation form, or further information on my/our right to cancel a PAD Agreement, at my/our financial

institution or by visiting www.cdnpay.ca.

I/We acknowledge that provision and delivery of this Agreement to you constitutes delivery by me/us to my/our financial Institution.

Any delivery of this Agreement to you constitutes delivery by me/us.

If there is a change in the Monthly Fixed Withdrawal Amount, I/we will receive written notice from you of the change at least

10 calendar days before the due date of the first revised PAD, and such notice shall be provided every time there is a change in the

Monthly Fixed Withdrawal Amount.

I/We acknowledge that my financial institution is not required to verify that a PAD has been issued in accordance with the particulars

of this Agreement, but not limited to, the Monthly Fixed Withdrawal Amount.

I/We acknowledge that my financial institution is not required to verify that any purpose of payment for which the PAD was issued has

been fulfilled by you as a condition of honouring a PAD issued or caused to be issued by you on my/our Account.

Revocation of this Agreement does not terminate any contract for goods or services that exists between me/us and you. My/Our

authorization applies only to the method of payment and does not otherwise have any effect on the contract for goods or services

exchanged.

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 debit that is not authorized or is not consistent with this Agreement. To obtain more information on my/our

recourse rights, I/We may contact my/our financial institution or visit www.cdnpay.ca.

I/We acknowledge that it is my/our responsibility to confirm that payments are withdrawn in accordance with this Agreement. I/We

may dispute a PAD under the following conditions:

(i) the PAD was not drawn in accordance with this Agreement; or

(ii) my/our authorization in this Agreement was revoked; or

(iii) written notice of a change in the Monthly Fixed Withdrawal Amount or the Payment Due Date was not provided at

least 10 calendar days prior to the next withdrawal.

In order to be reimbursed, I/we acknowledge that a declaration to my/our Financial Institution to the effect that either (i), (ii) or (iii) took

place, must be completed and presented to the branch of the financial Institution holding my/our Account up to and including

90 calendar days in the case of a personal household PAD (or up to and including 10 business days in the case of a business PAD),

after the date on which the PAD in dispute was posted to my/our account.

I/We acknowledge that a claim on the basis that my/our authorization was revoked, or any other reason, is a matter to be resolved

solely between you and me/us when disputing any PAD after 90 calendar days in the case of a personal household PAD or

10 business days in the case of a business PAD.

I/We agree to comply with the Rules of the Canadian Payments Association or any other rules or regulations which may affect the services

described herein, as may be introduced in the future or are currently in effect and I/we agree to execute any further documentation which

may be prescribed from time to time by the Canadian Payments Association in respect of the services described herein.

DISTRIBUTE AS FOLLOWS

Copy to:

Winnipeg

Vertica Branch

Vertica Property Manager

Tenant / Resident

Instructions on how to complete a Pre-Authorized Debit (PAD) Agreement Form

Important Note:

The PAD Agreement form must be completed properly and signed. Vertica staff members are not authorized to make

any changes to your PAD application. Please ensure that you have read and understood all

the terms and conditions

on this form.

Instructions:

All information requested on the PAD Agreement Form must be completed, as follows:

1. Name of Account Holder – Please print as shown on your cheque/financial institution record.

2. Financial Institution (F/I) Information – Complete information as shown on the void cheque (or letter from F/I)

that you provided:

a. Name of F/I – this is the name of your bank.

b. Address of F/I – this is the bank’s street number and name.

c. City or Town.

d. Province.

e.* F/I Branch/Transit Number – 5 digits.

f.* F/I Number – 3 digits.

g.* F/I Account Number.

   Example ChequeNo. 004

       Date: 

YourName

YourAddress

YourCity,Province,Canada





 

PaytotheOrderof   $  

          Dollars

 

 BankName

 BankAddress Signature

 BankCity&PostalCode

 







           

 e* f* g*

Cheque #

- not required

Branch/Transit #

- 5 digits

Institution #

- 3 digits

Account # - exactly as shown on cheque

- in this example 12341234567

3. Effective Date – This is the date of 1

rent withdrawal/payment.

4. Monthly fixed withdrawal Amount – Enter amount of your monthly rent payment.

5. PAD Type – Indicate whether Business or Personal.

6. Type of Account – Indicate Chequing or Savings (note: withdrawal cannot be made from non-chequing savings

accounts or line of credit accounts).

7. Sign and Date the PAD Agreement form – All persons who have signing authority on the bank account must

sign and date the form.

8. Provide your address, postal code and phone number – These must be provided (fax number is optional).

Please note:

Once the PAD Agreement form is completed and signed, please return the form along with a Void cheque to the Resident

Service Centre. A photocopy of a void cheque is also acceptable. If a cheque is not available, a letter from your Financial

Institution verifying your name, address and banking information will also be accepted.

Fill Online, Printable, Fillable, Blank Pre-Authorized Debit (PAD) Agreement FOR INTERNAL USE ONLY Form

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Fillable Pre-Authorized Debit (PAD) Agreement FOR INTERNAL USE ONLY

Fill Online, Printable, Fillable, Blank Pre-Authorized Debit (PAD) Agreement FOR INTERNAL USE ONLY Form

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