Pre-Authorized Debit Agreement

I authorize PISE (Pacific Institute for Sport Education) and the financial institution designated (or any other financial institution I may authorize at any time) to begin deductions as per my instructions for monthly regular recurring payments, for payment of all charges arising under my PISE membership(s). Regular monthly payments of $42.00 (incl. GST), the full amount of monthly membership will be debited to my specified account on the 15th day of each month. There will be 7 monthly pre-authorized debits. 

This authority is to remain in effect until the end of the membership term.

I understand that there is an NSF (No Such Funds) fee of $35 plus GST. 

The Payee in this agreement is: 

Pacific Institute for Sport Excellence Society

4371 Interurban Rd

Victoria, BC 

250-220-2510

accountspayable@pise.ca

AUTHORIZATION: 

I acknowledge that this agreement is provided for the benefit of the "Payee" and "Processing Institution" and is provided in consideration of the Processing Institution agreeing to process debits (PADs) against the Account with the Processing Institution in accordance with the Rules and the Canadian Payments Association (the CPA Rules).

By signing this agreement the Payor acknowledges having received and having read a copy of this agreement, including the terms and conditions. 

 

Waiver of pre-notification (Does not apply to specific PAD's)

I waive any and all requirements of pre-notification of debiting, including, without limitation, pre-notification of any changes in the amount of the PAD due to a change in any applicable tax rate, top-up, or adjustment. 

 

 
 
 
 
 
 
 
 
 
 
 
 
 

Signee Information

Attachments

A void cheque or your banking information is required for monthly automated payment plan

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.