Payor's Authorization
I (We) acknowledge that this authorization form is provided for the benefit of the Payee (identified hereinafter) and my financial institution as is provided in consideration of my financial institution agreeing to process debits against my account in accordance with the Rules of the Canadian Payments Association.

Payee
This section has been filled to designate the payee.

I (we) warrant and guarantee that all persons whose signatures are required to sign on this account have signed the agreement below.

I (we) hereby authorize the Payee identified above to draw on my (our) account number with my (our) financial institution, for the following purpose.

Internet Dedicated Access

This authorization may be cancelled at any time upon notice by me (us). I (We) acknowledge that, in order to revoque this authorization, I (We) must provide notice of revocation to the Payee.

I (We) acknowledge that provision and delivery of this authorization to the Payee constitute delivery by me (us) to my (our) financial institution. Any delivery of this authorization to you constitutes delivery by me (us).

I (We) acknowledge that this authorization concerns only pre-authorized debits in the following categories in accordance with Rule H4 of the Canadian Payments Association.

In the case of "personal/household" pre-authorized debits, I (We) shall receive, with respect to the debiting of fixed-amounts payments, written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days prior to the due date of the first payment, and such notice shall be received each time there is a change in the amount or payment date(s); or, with respect to the debiting of variable-amount payments, written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days prior to each payment due date.

In the case of "business" pre-authorized debits, I (We) shall receive, with respect to the debiting of fixed-amount payments, written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days prior to the due date of the first payment, and such notice shall be received each time there is a change in the amount or payment date(s); or, with respect to the debiting of variable-amount payments, written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days prior to each payment due date.

The account that the Payee is authorized to draw upon is indicated below. A specimen cheque, if available for this account, has been marked "VOID" and attached to this authorization. I (We) undertake to inform the Payee, in writing, of any change in the account information provided in this authorization prior to the next payment due date.

Identification of payor
This section must be filled by payor.  Please print.

I (We) acknowledge that my (our) financial institution is not required to verify that the pre-authorized debit was issued in accordance with the particulars of the Payor's Authorization, but not limited to, the amount.

I (We) acknowledge that, my (our) financial institution is not required to verify that any purpose of payment for which the payment was issued has been fulfilled by the Payee as a condition to honouring the pre-authorized debit issued or caused to be issued by the Payor on my (our) account.

Revocation of this authorization does not terminate any contract for goods and services that exists between myself (ourselves) and the Payee. The Payor's Authorization applies only to the payment method and does not otherwise have any bearing on the contract for goods or services exchanged.

I (We) may dispute a pre-authorized debit under the following conditions.

1. the payment was not drawn in accordance with the Payor's Authorization; or

2. the authorization was revoked; or

3. pre-notification was not received.

I (We) acknowledge that, in order to be reimbursed, a declaration to the effect that i., ii. or iii. took place must be completed and presented to the branch of my (our) financial institution either up to and including ninety (90) calendar days in the case of a "personal/household" pre-authorized debit, or up to and including ten (10) business days in the case of a "business" pre-authorized debit, after the date on which the payment in dispute was posted to my (our) account.

I (We) acknowledge that a claim on the basis that the Payor's Authorization was revoked, or any other reason, is a matter to be resolved solely between the Payee and myself (ourselves) when disputing any pre-authorized debit after ninety (90) calendar days in the case of a "personal/household" pre-authorized debit or ten (10) business days in the case of a "business" pre-authorized debit.

I (We) understand and accept this pre-authorized debit plan and wish to enroll therein. Furthermore, I (We) agree that any personal information that might be contained in this Payor's Authorization may be disclosed to the Payee's financial institution, to the extend that such disclosure is directly related to and necessary for the proper application of Rule H4 of the Canadian Payments Association.

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Signature (as it appears on the cheques)                       Date


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Signature (as it appears on the cheques)                       Date


I (We) agree to waive receipt of the notices mentioned above in relation to "business" pre-authorized debits.


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Signature (as it appears on the cheques)                       Date


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Signature (as it appears on the cheques)                       Date