Registration Form
President’s Choice Financial® MasterCard® Pre-Authorized
Debit (PAD) Payment Service Agreement (Personal)
. Please complete all sections in order to instruct your financial institution to
make payments to your PC MasterCard directly from your bank account.
. Please read the Authorization terms below, complete and sign this form,
and return it to us by mail, email, or fax to:
P.O. Box
Station A
Toronto, Ontario
MW Y
Email: documentspcmastercard.ca
Fax:
. If you have any questions, please contact our customer service line
at (the number on the back of your credit card)
hours a day, days a week.
This Pre-Authorized Debit (PAD) Payment Service Agreement (Personal)
will take effect on your next payment due date provided that we receive
the completed and signed form at least business days before the next
payment due date.
• To change any of your bank account information, you must complete
and resubmit a new Pre-Authorized Debit (PAD) Payment Service
Agreement (Personal) form in accordance with the terms set forth.
• You have certain recourse rights if any debit transaction does not comply
with this Authorization. For example, you have the right to receive
reimbursement for any debit transaction that is not authorized or is not
consistent with this Authorization. To obtain more information on your
recourse rights, please contact your financial institution or visit cdnpay.ca.
• You may cancel your Authorization of the Pre-Authorized Debit (PAD)
Payment Service Agreement (Personal) at any time subject to providing
us with days’ prior notice from the next payment due date. You must
provide us this notice in writing by completing the PAD Cancellation
form. To obtain a copy of the PAD Cancellation form, please visit our
website at pcfinancial.ca/pad, and for more information on your rights
to cancel the Pre-Authorized Debit (PAD) Payment Service, please
contact your financial institution or visit cdnpay.ca.
Please indicate the following by checking the appropriate box:
New PAD Request
Update Pre-existing PAD
1. President’s Choice Financial MasterCard Primary Cardholder Information (please print clearly)
First Name:
Initial: Last Name:
President’s Choice Financial MasterCard Card Number:
Street Number: Street Name:
Unit Number: Rural Route (R.R.) Number: Post Office Box:
City/Town: Province: Postal Code:
Home Telephone Number: ( ) - Business Telephone Number: ( ) - Ext.
2. Primary Cardholder’s Bank Account Information (please print clearly)
Transit #:
Bank ID:
Bank Account Number:
Chequing Savings
Financial Institution: Name: Branch Address:
3. Timing and Amount
You authorize us to process pre-authorized debits against the bank account from the
financial institution identified above each month as indicated on your monthly statement.
The payment option you choose below will be withdrawn on the due date indicated on
your monthly statement, less any amounts paid by you before the payment due date.
Please check one of the following payment options:
Minimum Payment Due
Full Statement Balance
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Where to find this information
