Pre-Authorized Debit (PAD) Agreement Gan - Shalom Preschool | 10500 Bathurst St., Vaughan, ON L6A 0H2 | Tel: 905-303-1880 Payor Agreement: Payor Information Child Name* Child First Name Child Last Name Child Name Child First Name Child Last Name Child Name Child First Name Child Last Name Payor's Name (Parent)* Child First Name Child Last Name Payor's Name (Other Parent) Child First Name Child Last Name Payor's Mailing Address:* Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Payor's Cellphone Number :* Payor Agreement: Payor Bank Information Upload a Void Cheque image Here. File must include: Name of Financial Institution Branch Transit Number Financial Institution Number Bank Account Number or a Pre-Authorized Info Sheet if a cheque is not available (see your financial institution). Upload Here* Terms and Conditions 1. I (the Payor) authorize Gan - Shalom Preschool (the Payee) to withdraw Pre-Authorized Payments from the above designated bank account, of which I am the/an authorized signatory. If I am not the authorized signatory or if this is a joint account, the appropriate signature is also provided below. Your Initials Here:* 2. I confirm that the person(s) whose signature(s) is/are required for the above noted bank account have signed this PAD Payor Agreement (PAD Agreement) and the information provided above is accurate and complete. Your Initials Here:* 3. I understand that the outstanding debt covered by this PAD Agreement as of the date of signature(s) below will continue to accrue applicable interest and/or fees during the term of this PAD Agreement where authorized to do so. In the event of a residual balance on the account that is less than the fixed instalment amount, Gan - Shalom Preschool will contact the Payor to negotiate the settlement of the residual amount. Y Your Initials Here:* 4. In the event that new debt is incurred by the Payor while this PAD Agreement is in effect, Gan - Shalom Preschool will contact the Payor to discuss the new debt and negotiate another PAD Agreement for the new debt. Your Initials Here:* 5. I understand that I may cancel this PAD Agreement at any time by providing written notice to Gan - Shalom Preschool, at the address indicated above. This notification must be received by no later than twenty (20) days before the next scheduled withdrawal. Your Initials Here:* 6. I agree to inform Gan - Shalom Preschool, in writing at the address noted above, of any change in the above information (for example, banking information/recurring instalment amount). This notification must be received by no later than twenty (20) days before the next scheduled withdrawal. Your Initials Here:* 7. I understand that cancellation of this PAD Agreement refers to the method of payment only and does not negate the Payment Plan between myself and Gan - Shalom Preschool or any financial obligations to repay my debt that is owed to the Crown. Your Initials Here:* 8. I waive my right to receive pre-notification of the amount of the periodic PAD and agree that I do not require advance notice of the amount of PAD before a withdrawal is processed. Your Initials Here:* 9. I agree that in the event of a non-negotiable payment (e.g.: NSF, account closed, etc.), I will be liable to a charge equal to an NSF fee. Your Initials Here:* 10. In the case of an unsuccessful withdrawal attempt (e.g.: NSF), I agree that the outstanding amount will be withdrawn with the subsequent instalment that is made under this PAD Agreement. In the event of reoccurring unsuccessful PAD withdrawals, Gan - Shalom Preschool may terminate this PAD Agreement and resume collection actions. Your Initials Here:* 11. I acknowledge that acceptance of this payment method is subject to the discretion of Gan - Shalom Preschool. Your Initials Here:* 12. I agree that I may dispute a PAD only under the following conditions: (i) the PAD payment was not in accordance with this PAD Agreement, (ii) the PAD Agreement was revoked. Your Initials Here:* 13. The Payor shall indemnify and hold harmless Gan - Shalom Preschool from and against any and all liability, loss, costs, damages and expenses (including legal, expert and consultant fees), causes of action, actions, claims, demands, lawsuits or other proceedings (collectively, "Claims"), by whomever made, sustained, incurred, brought or prosecuted, including for any third party liability, in any way based upon, occasioned by or attributable to anything done or omitted to be done by the Payor in connection with this Agreement unless solely caused by the negligence or willful misconduct of Gan - Shalom Preschool. Your Initials Here:* 14. I consent to the collection, use, and disclosure of my personal and financial information by Gan - Shalom Preschool for the purpose of processing these pre-authorized debits. Your Initials Here:* 15. I confirm I have read, understood and agreed to the above Terms and Conditions of this PAD Agreement. Payor’s Recourse/Reimbursement Statement: As a payor, you have certain recourse rights if any withdrawal does not comply with this agreement. For example, you have the right to receive reimbursement for any withdrawal that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, you may contact your financial institution or visit Canadian Payments Association Rule H1 Pre-Authorized Payments (PADs) Part VII- Reimbursement and Recourse. I declare that the information provided in this agreement is accurate and complete to the best of my knowledge. I acknowledge that my electronic signature on this document is legally binding and has the same effect as a handwritten signature. Payor’s Signature (First and Last Name)* Date today:* Month Day Year Submit Should be Empty: This page uses TLS encryption to keep your data secure.