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QuestionAnswer
Form NameBmo Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesbmo pre authorized debit form, bmi formula calculation, form pre authorized, pad form

Form Preview Example

Payor’s PAD Agreement

Personal Pre-Authorized Debit Plan

Authorization of the Payor to the Payee to Direct Debit an Account

Instructions:

1.Please complete all sections in order to instruct your financial institution to make payments directly from your account.

2.Please see the Terms and Conditions on the reverse of this document.

3.Return the completed form with a blank cheque marked “VOID” to the Payee at the address noted below.

4.If you have any questions, please write or call the Payee.

Payor Information (please type or print clearly)

Payor Name

 

 

 

 

 

 

 

 

 

 

 

 

Payor Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

(

 

)

 

 

 

 

 

 

(

 

)

 

Telephone No.

 

 

 

 

 

Telephone No.

 

 

 

 

 

 

DD MM

 

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

Date

 

 

 

 

 

Signature

 

 

DD MM YYYY

Date

Payor Financial Institution/Banking Information (please type or print clearly)

0 0 1

9 1 0 5 2

0 0

1

Branch No.

Institution No. Account No.

Line of Credit Account Number

 

 

 

 

 

 

Name of Financial Institution

 

Branch

 

 

 

 

 

 

 

Branch Address

 

City/Province

Postal Code

Payee Information (please type or print clearly)

Payee Name(s)

Address

()

City/Province

DD MM YYYY

Postal Code

DD MM YYYY

Telephone No.

Date

 

 

Reference # or Account #

 

Service or Utility

Start Date

Payment Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please specify whether the payment is a:

 

 

Occurring at:

 

Are top-ups or adjustments permissible?

(Please check one)

 

 

(Please check one)

 

(Please check one)

 

Fixed Amount: (Please specify)

 

 

Set Intervals: Please specify the timing

 

Yes

 

 

 

 

 

 

(i.e. weekly, bi-weekly, monthly)

 

No

 

Variable Amount: If variable, please specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

whether there is a maximum amount, or

 

Sporadic Intervals:

 

 

 

indicate N/A if there is no maximum

 

 

 

 

 

 

 

Amount:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prod. 1093771 - Form 3360 (01/10)

 

 

 

 

 

 

 

Delete either 6(a) or 6(b) as applicable

If Payor agrees to waive pre- notification, Payor must sign where indicated

PAYOR’S PAD AGREEMENT

Personal Pre-Authorized Debit Plan

Terms & Conditions

1.In this Agreement , “I”, “me” and “my” refers to each Account Holder who signs below.

2.I agree to Bank of Montreal and any successor or assign of the Bank (the "Bank") debiting my account indicated on the reverse(the"Account")forpersonal/householdorconsumerpurposesandIauthorizethePayeeindicatedonthereverseand any successor or assign of the Payee to draw a debit in paper, electronic or other form, including any top-ups or adjustments, for the purpose of making payment for consumer goods or services (a "Personal PAD"), on my Account at the financial institution indicated on the reverse (the "Financial Institution") and I authorize the Financial Institution to honour and pay suchdebits. ThisAgreementandmyauthorizationareprovidedforthebenefitofthePayeeandmyFinancialInstitutionand are provided in consideration of my Financial Institution agreeing to process debits against my Account in accordance with the Rules of the Canadian Payments Association. I agree that any direction I may provide to draw a Personal PAD, and any Personal PAD drawn in accordance with this Agreement, shall be binding on me as if signed by me, and, in the case of paper debits, as if they were cheques signed by me.

3.If the amount that I am required to pay under my agreement with the Payee changes, this authorization will continue to apply. I may revoke authorization at any time, subject to providing notice to the Bank: this authority is to remain in effect until the Bank has received written notification from me of its change or termination. This notification must be received at least 30 days before the next debit is scheduled at any branch of the Bank of Montreal. I may obtain a sample PAD cancellation form or more information on my right to cancel a PAD Agreement at any branch of my financial institution or by visiting www.cdnpay.ca.

This authorization applies only to the method of payment and I agree that cancellation of this authorization does not terminate or otherwise have any effect on any contract that exists between me and the Bank.

4.I agree that my Financial Institution is not required to verify that any Personal PAD has been drawn in accordance with this Agreement, including the amount, frequency and fulfillment of any purpose of any Personal PAD.

5.I agree that delivery of this Agreement to the Payee constitutes delivery by me to my Financial Institution. I agree that the Payee may deliver this Agreement to the Payee’s financial institution and agree to the disclosure of any personal information which may be contained in this Agreement to such financial institution.

6.(a) I understand that with respect to:

(i)fixed amount Personal PADs occurring at set intervals, I shall receive written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days before the due date of the first Personal PAD, and such notice shall be received every time there is a change in the amount or payment date(s);

(ii)variable amount Personal PADs occurring at set intervals, I shall receive written notice from the Payee of the amount to be debited and the due date(s) of debiting, at least ten (10) calendar days before the due date of every Personal PAD; and

(iii)fixed amount and variable amount Personal PADs occurring at set intervals, where the Personal PAD Plan provides for a change in the amount of such fixed and variable amount PADs as a result of my direct action (such as, but not limited to, a telephone instruction) requesting the Payee to change the amount of a PAD, no pre-notification of such changes is required.

-OR -

(b) I agree to waive the pre-notification requirements in section 6(a) of this Agreement.

Signature of Payor

7.I agree that with respect to Personal PADs, where the payment frequency is sporadic, a password or secret code or other signature equivalent will be issued and shall constitute valid authorization for the Payee or its agent to debit my account.

8.I certify that all information provided with respect to the Account is accurate and I agree to inform the Payee, in writing, of any change in the Account information provided in this Agreement at least ten (10) business days prior to the next due date of a Personal PAD. In the event of any such change, this Agreement shall continue in respect of any new account to be used for Personal PADs.

9.I warrant and guarantee that all persons whose signatures are required to sign on the Account have signed this Agreement below. In addition I warrant and guarantee, where applicable, that I have the authority to electronically agree to commit to this Agreement by secure electronic signature and that my secure electronic signature conforms with the requirements of Rule H1.

10.I acknowledge receipt of a copy of this Authorization.

11.Applicable to the Province of Quebec only: It is the express wish of the parties that this Agreement and any related documents be drawn up and executed in English. Les parties conviennent que la présente convention et tous les documents s’y rattachant soient rédigés et signés en anglais.

12.I have certain recourse rights if any debit does not comply with this PAD 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 your recourse rights, contact any Branch of the Bank of Montreal or visit www.cdnpay.ca.

I have full responsibility to complete this form along with the payee.

I acknowledge that Bank of Montreal has no responsibility to complete this form, and understand that this pre-authorized debit form may not be processed by the payee or the payee’s financial institution if all sections are not completed correctly.

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1. When filling out the form bmo, be sure to include all important fields in its corresponding part. This will help to hasten the process, allowing your information to be processed quickly and correctly.

Ways to prepare form pre authorized debit download portion 1

2. Once your current task is complete, take the next step – fill out all of these fields - Payee Names, Address, Telephone No, DD MM, YYYY, CityProvince, Postal Code, DD MM, YYYY, Date, Reference or Account , Service or Utility, Start Date, Payment Information, and Please specify whether the payment with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Simple tips to fill out form pre authorized debit download part 2

3. Your next part will be hassle-free - complete all of the form fields in I agree to waive the, If Payor agrees to waive pre, Signature of Payor, I agree that with respect to, I certify that all information, I warrant and guarantee that all, I acknowledge receipt of a copy of, Applicable to the Province of, I have certain recourse rights if, and To obtain more information on your to complete this part.

Filling out part 3 in form pre authorized debit download

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