Dormition Parish Pre-Authorized Debit (PAD)

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I want to support the Ukrainian Catholic Parish of Parish of the Dormition of the Blessed Mother of God through monthly donations by pre-authorized debit (PAD).

Email *

Please debit my bank account the following amount every month: *

$50

$100

$250

Other:

The debit transaction will be processed to your account on the 18th day of each month or the next business day.

Donor First Name: *

Donor Last Name: *

Street Address: *

City: *

Province: *

Postal Code: *

Telephone Number: *

This donation is made on behalf of: *

an Individual/Family

a Business

Bank Account Information

Sample Void Cheque

Transit Number: *

(5 digits)

Financial Institution Number: *

(3 digits)

Account Number: *

(7 - 10 digits)

I may revoke my authorization at any time, subject to providing notice of 30 days. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution or visit www.cdnpay.ca

I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca

I agree to authorize the Ukrainian Catholic Parish of Parish of the Dormition of the Blessed Mother of God to debit my bank account the amount indicated above. *

I agree

Required

Initials *

A copy of your responses will be emailed to the address you provided.

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