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COMPLETE YOUR BANKING INFORMATION



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  1. COMPLETE YOUR BANKING INFORMATION:



PAYMENT – PRE-AUTHORIZED PAYMENT (PAP) DETAILS: Please complete the following, or attach a VOID cheque.

Name of Financial Institution: ____________________________


Branch number: __I__I__I__I__I (five digits) Institution number: __I__I__I (three digits)
Account number: __I__I__I__I__I__I__I__I__I__I__I__I (maximum of twelve digits)



Please Withdraw Funds:  Full amount on 1st of month

 ½ of amount on 1st and ½ of amount on 15th of month


Banking changes: To change the details of your PAP, an email or fax must be received by the 20th of the month to be set up for the following month.

I/we the undersigned authorize Community Charity Services (CCS) to debit my/our account at the financial institution indicated under the terms and conditions agreed by me/us with CCS until such time as written notice to the contrary is given by me/us to CCS.


I/we have read and understood the terms and conditions and hereby accept them as a condition of my/our participation in PAP.

_________________________________ ________________________



Signature Date





  1. MAIL, FAX or SCAN EMAIL YOUR REGISTRATION FORM TO:



Community Charity Services



Address: 25 Industrial Drive, Elmira ON N3B 3K3 Phone: 519-669-1081 or 866-669-2276 Fax: 519-669-2573

E-mail: service@charityservices.ca Website: www.charityservices.ca


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