Please complete the Pre-Authorized Debit (PAD) Plan agreement below.

I/we authorize 1

Class Preschool Inc. and the nancial institution designated (or any other nancial insti-

tution 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 for childcare

and/or preschool for my child, _________________________________. Regular monthly payments for the

full amount of program fees plus any late fees and/or declined payment fees will be debited to my/our

specied account on the 1

day of each month. 1

Class Preschool Inc. will obtain my/our authorization for

any other one-time or sporadic debits.

This authority is to remain in eect until 1

Class Preschool Inc. has received written notication from

me/us of its change or termination. This notication 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 nancial institution or by visiting

www.payments.ca

Class Preschool Inc. 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 nancial institution or visit www.payments.ca

PLEASE PRINT

Date: ________________________________ Program Location: ______________________

Name(s): _____________________________ Child’s Name: __________________________

Financial Institution (FI): _______________________________________________

FI Account Number: _______________________ FI Transit Number: _______________-_____________

(Branch -5 digits; FI – 3 digits)

Address: ____________________________________________

City/Town: _______________________ Province: _____________________ Postal Code: ______

Authorized Signature(s): _________________________________________________

PRE-AUTHORIZED DEBIT

PAD FORM

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