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Dormition Parish Pre-Authorized Debit (PAD)
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).
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Email
*
Your email
Please debit my bank account the following amount every month:
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$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:
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Your answer
Donor Last Name:
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Your answer
Street Address:
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Your answer
City:
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Your answer
Province:
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Your answer
Postal Code:
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Your answer
Telephone Number:
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Your answer
This donation is made on behalf of:
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an Individual/Family
a Business
Bank Account Information
Sample Void Cheque
Transit Number:
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(5 digits)
Your answer
Financial Institution Number:
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(3 digits)
Your answer
Account Number:
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(7 - 10 digits)
Your answer
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.
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I agree
Required
Initials
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Your answer
A copy of your responses will be emailed to the address you provided.
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