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Pre-Authorize Debit Form
The undersigned authorizes
Capital Alliance Inc.
(hereinafter called the "Payee") to issue on his/her behalf any cheque, payment order or request drawn on the financial institution named below to the order of the Payee, in payment of the amounts owing to the Payee under the terms of the present agreement and future contracts between the Payee and the undersigned.
Type of Service
Monthly Rent Amount
The above-named institution is hereby authorized to debit the account described above payable to the Payee and drawn on said account by a bank acting in the name of the Payee. The amount authorized by this Monthly transaction is[ Monthly Rent Amount]. Any request thus drawn by the Payee's bank shall be considered as having been signed by the undersigned. For the purposes of this authorization, the word "cheque" shall be deemed to include any payment order drawn on an institution other than a bank. Furthermore, if this authorization is signed by more than one person, the singular shall be interpreted as a plural wherever it occurs. This authorization can be revoked at any time by written notification to the Payee at the address below, subject to providing notice of 30 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD agreement, contact your financial institution or visit www.cdnpay.ca. You [or I/We depending on the context] have certain recourse rights if any debit does not comply with this agreement. For example, you [I/we] 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 your [my/our] recourse rights, [I/we] may contact your financial institution or visit www.cdnpay.ca.
Accepted file types: pdf, png, jpg, jpeg, , Max. file size: 32 MB.
Please upload your void cheque here
Please attach a sample of a cheque marked "VOID" from the above-mentioned institution. If the account requires two signatures, then the present authorization should be signed by the same two officers.
Capital Alliance Inc. 7905 Bayview Ave. Suite 413, Thornhill, ON L3T 7N3
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