PAD Application Form

Date: 01/19/2021

Estate information

Estate No.:*

Name*

Prefix First Middle Last

Address*

Street Address Address Line 2 City Province Postal code

Phone*

Email*

Banking information

Void cheque*

(Please ensure to upload a specimen "VOID" cheque to this application)

Financial Institution:*

Address*

Street Address Address Line 2 City Province Postal code

Account type*

Personal
Business

Bank No.:*

SIB ACCT#:*

Transit No.:*

Debit Amount:*

Beginning Date of Debit:

*

I/we hereby agree to inform SCB, in writing, or by fax, of any change in the information provided in this section at least thirty (30) days prior to the next due date of the Pre-Authorized Debit, as defined in Canadian Payment Association ("CPA") Rule H1 ("PAD").*

*

I/we hereby acknowledge that payments are processed automatically and SCB cannot edit/modify/remove transactions within 72 hours of the date of the transaction (business hours apply). Notice must be received at least three (3) banking days prior to the transaction date. SCB reserves the right to charge an administration fee of $25 to edit/modify/remove payment transactions based on the frequency of requests.*

*

I/we hereby acknowledge and agree that payments will be processed each month on the date (or first banking day following) noted above.*

Notification to SCB:

SMITH CAGEORGE BAILEY INC.
210, 617 11 Avenue SW
Calgary, AB T2R 0E1
Facsimile: (403) 452-8187
e-mail: preauthorized@scbsolutions.ca

*

I/we acknowledge that the Authorization is provided for the benefit of SCB In Trust and the Processing Member and is provided in consideration of the Processing Member agreeing to process debits against our account referred to above in Section 1 (the "Account") in accordance with the Rules of the Canadian Payments Association.*

*

I/we warrant that all persons whose signatures are required to authorize withdrawals from the Account have signed this Authorization and that all such persons have authority to enter into this Authorization and to bind the Estate referenced.*

*

I/we hereby authorize SCB to issue PADs drawn on the Account, to collect all fees payable pursuant to the terms outlined and detailed within the Estate documents executed by the Debtor(s).*

*

I/we may revoke this Authorization at any time upon providing written or faxed notice to SCB within 30 days before the next PAD was to be issued. Notices must include: date of PAD, Estate Name(s), amount of debit, reason for revocation, confirmation of all contact information.*

Cancelling the Authorization does not affect the obligations of the Debtor(s) pursuant to the terms outlined in the proposal/bankruptcy documents.

*

I/we acknowledge and agree that providing and delivering this Authorization to SCB constitutes delivery by us to the Processing Member.*

*

I/we agree to waive any requirement that SCB give pre-notification of any payment amount unless the payment amount differs from the amount detailed herein.*

*

SCB may issue a PAD monthly.

*

I/we hereby acknowledge that PADs not honored by the Processing Member, for whatever reason, will result in a fee of $45.00. It is further agreed that SCB shall not automatically reprocess a PAD without written instruction. The Debtor is required to authorize SCB in writing to process any payments outside the payments authorized herein. SCB will require a written authorization to reprocess the dishonored payment and a second authorization to process the NSF fee. The NSF fee will be required to process the replacement payment.

*

I/we acknowledge that the Processing Member is not required to verify that a PAD has been issued in accordance with the particulars of this Authorization including, but not limited to, the amount, or that any purpose of payment for which the PAD was issued has been fulfilled by SCB as a condition to honoring a PAD issued or caused to be issued by SCB on the Account.

*

I/we acknowledge and agree that a PAD may be disputed only if:
- 1. The PAD was not drawn in accordance with this Authorization
- 2. This Authorization was revoked in accordance with section 7 above.
I/we acknowledge and agree that in order to be reimbursed a declaration to the effect that either (i) or (ii) took place, must be completed and presented to the branch of the Processing Member holding the account up to and including 30 business days after the date on which the PAD in dispute was posted to the Account. In the event that that such declaration is not provided within the time period described, the dispute shall be resolved solely between us and SCB outside of the payments system. I/we have certain recourse rights if any debit does not comply with the terms of the Authorization. For example, we have the right to receive reimbursement for any debit which is not authorized or is not consistent with this Authorization. To obtain more information on our recourse rights, we may contact the Processing Member or visit www.cndpay.ca.

*

Any term not otherwise defined herein and which appears in the "definition" section of CPA Rule H1 shall have meaning ascribed to it herein.

*

I/we hereby acknowledge and agree to the terms of this Authorization and consent to the disclosure of any personal information contained herein to the Processing Member to the extent necessary for the proper application of CPA Rule H1.

Signature*

If you are unable to complete the electronic signature you are required to print and sign the form and submit it by fax or email. Upon submission, the results of this form will be emailed to you. Simply print your email, sign and fax back to us.

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Phone

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Pre-Authorized Debit (PAD) Application Form

Estate information

Banking information