Automatic Bank Withdrawal

Fields marked with an * are required. To view a sample of a Canadian cheque, click here. (Please note: you will need to open it in a new tab to avoid losing any filled-in content.)

Your name *

Email address *

Phone number *

What would you like to do? *

If your account is a joint account, please add the second person's full name.

Address

I/we would like to receive news and information from Paris Community Church. I/we understand that this may include promotions and requests for donations.

Terms and Conditions *

I/we have read and agree to the following conditions: This authorization will be in force until I/we give Paris Community Church written notice, at least 30 days in advance, to end the PAD (pre-authorized debit), otherwise called automatic withdrawal. I/we may revoke our authorization at any time, subject to providing notice of 30 days. 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 debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on our recourse rights or about cancelling a PAD agreement, I/we may contact my financial institution or visit www.cdnpay.ca.

I/we agree with the terms and conditions.

I/we DO NOT agree with the terms and conditions.