Pardner Up - PAD Form (Monthly) Please select your contribution designation to begin*OperationsStaff - Tony PosthumusStaff - Christine MossChaplaincyCreated to CreatePassagesPlease use the sample cheque below to find the information on your own cheque to enter the data needed in the form below to process your monthly pledge. Name* First Last Email* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*Account Type*CheckingSavingsType of Pre-Authorized Debit*PersonalBusinessBranch Number (5 digits - see sample)*Please enter a value less than or equal to 99999.Institution Number (3 digits - see sample)*Please enter a value less than or equal to 999.Account Number*Amount of Monthly Donation*25020015010075503525OtherPlease specify the amount:*Payment Date (1st or 16th of each month)*1st16thPayments will start on the nearest date once form is submitted. If you have any questions, please contact the Northumberland YFC offices at 905.373.4707 or email at firstname.lastname@example.org. Thank you for your support! Your Payor's Pre-Authorized Debits (PADs) agreement may be cancelled provided notice is received thirty (30) days before the next scheduled PAD. If any of the above details are incorrect, please contact us immediately at email@example.com. If the details are correct, you do not need to do anything further and your Pre-Authorized Debits will be processed and start on the payment start date indicated in the form you completed which will either the 1st or 16th of each month. You have certain recourse rights if any debit does not comply with these terms. For example, you have the right to receive a reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit Canadian Payments Association at cdnpay.ca. Payor's Acceptance and Authorization* YES || I/We, by selecting "YES" and submitting this form, authorize Northumberland Youth for Christ (the Payee) to issue PADs (as defined in CPA, Rule H1) drawn on the above account in accordance to the "Terms and Conditions" of the Pre-Authorized Agreement for the agreed upon amount on a monthly basis. CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.