PRE-AUTHORIZED DEBIT (PAD) AGREEMENT ONLINE FORM

Type of Service: Business

Entity Legal Name
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code

Country

Contact Email

Authorization

  • I/we authorize Sparcblock (2144482 Ontario Limited) and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one-time payments from time to time, for payment of all charges arising from subscription services contracts which specify Sparcblock Pre-Authorized Debit (PAD) as the payment method. Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the 1st day of each month. Sparcblock will obtain my/our authorization for any other one-time or sporadic debits. This authority is to remain in effect until Sparcblock has received written notification from me/us of its change or termination. This notification must be received at least ten (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.payments.ca. Sparcblock 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.payments.ca.

Financial Institution (FI)

  • Toronto-Dominion Bank
  • Bank of Nova Scotia
  • Bank of Montreal
  • Royal Bank of Canada
  • Canadian Imperial Bank of Commerce
  • National Bank of Canada
  • Other:

FI Account Number

FI Branch Transit Number

FI Branch Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code

Country

Date

Your Name (Must be Signatory on Above Account)
First
Last

Your Signature

Clear Signature

Supporting Documents - these can be uploaded here or provided later

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