Pre-authorised debit (PAD)

PLAN AGREEMENT OF PRE-AUTHORIZED DEBIT (PAD)

I authorize BELISLE SOLUTION NUTRITION INC. 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 or one-time payments from time to time, for payment of all charges arising under my BELISLE SOLUTION NUTRITION INC. Services will be debited as per the fees stated on the billing agreement.

This authority is to remain in effect until BELISLE SOLUTION NUTRITION INC. has received written information from me or its change of termination. This notification must be received at least ten (10) days business days before the nest debit is scheduled at the address provided below. I may obtain a sample cancellation form, or more information on my right to cancel a PAD Agreement at my financial institution or by visition www.cdnpay.ca

BELISLE SOLUTION NUTRITION INC. 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.

I have certain recourse rights if any debit does not comply with this agreement. For example, I 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 recourse rights, I may contact my financial institution or visit www.cdnpay.ca

MEMBERSHIP FORM PRE-AUTHORIZED DEBIT (PAD)

Subjet *

Date *

Client Number *

Type of service *

Name *

Address *

City *

Province *

Code postal *

Cellulaire

Email *

Financial institution

Account number

Transit

Address

City *

Province *

Code postal *

Specimen of check *

Comment / question *

Signature

Séparez les adresses email par une virgule.

Submit

For information, contact our billing department by email at, recevbelisle.net

Voir notre Politique de confidentialité.