Pre-Authorized Debits (PADs) and Payor's PAD Agreement

Bank Account Details

To authorize us to charge your invoice payment through your bank account, please

1) Fill below PAD form and sign it

2) Attach your VOID cheque image file

Branch Transit Number

Financial Institution Number

Bank Account Number

Account Type

Branch Address

City

Province

Postal Code

I/we authorize CIK Telecom INC, and the financial institution above 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 under my/our CIK Telecom INC account(s).

Void Cheque Image File

(Max File Size 4MB)

Account Holder

(First Name)

Account Holder

(Last Name)

Account Holder Signature