Sign up for PAD – Sparcblock

PRE-AUTHORIZED DEBIT (PAD) AGREEMENT ONLINE FORM

Type of Service: Business

Type of Business *

Corporation
Partnership
Association or Other Entity

Entity Legal Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Name *

First

Last

Contact Phone *

Contact Cell Phone (if different than above)

Contact Email *

Authorization *

I/we authorize SparcPay and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one-time payments from time to time, for payment of all charges arising from subscription services contracts which specify SparcPay Pre-Authorized Debit (PAD) as the payment method. Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the 1st day of each month. SparcPay will obtain my/our authorization for any other one-time or sporadic debits. This authority is to remain in effect until SparcPay has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting www.payments.ca. SparcPay may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us. 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 PAD that is not authorized or is not consistent with this PAD Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.payments.ca.

Financial Institution (FI) *

FI Account Number *

Usually 7-12 digits, dashes are optional

FI Branch Transit Number *

Branch number (5 digits) then a dash and FI number (3 digits)

FI Branch Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date *

First Signatory on Above Account *

First

Last

First Signatory Signature *

Sign with mouse or touchscreen

Second Signatory

A second signature is required for this account and will be submitted with this form
A second signature is not required for this account
A second signature is required and will be submitted separately (via www.sparcblock.com/pad2)

Second Signatory on Above Account *

First

Last

Second Signatory Signature *

Sign with mouse or touchscreen, or leave blank to sign paper copy.

Upload an image of a void cheque here *