Whitehorse Condominium Corporation #290

Box 290, 420 Range Road

Whitehorse, Yukon, Y1A 3A2

Pre-Authorized Debit (PAD) Agreement for Whitehorse Condominium

Corporation #290

Customer Information (Please Print Clearly)

KEN LEON DSOUZA

Name: _________________________________________________________________

605 - 1565 RUE RACHEL EST

Street Address: _______________________________________________________________________

MONTREAL
City: ______________________ QUEBEC
Province: _________________ H2J 2K5
Postal Code: _____________________

Bank Account Information

TD CANADA TRUST
Financial Institution: __________________________________ 004
Financial Institution Number: _________

6005826
Account Number: ________________________ 01592
Branch Transit Number: _________________________

6760 Meadowvale Town Center, Mississauga, Ontario L5N 4B7

Branch Address: ______________________________________________________________________

Pre-Authorized Debit (PAD) Details

K1 Condo Corporation (#290)

You, the Payor, authorize _______________________________________________to debit the bank

$315.64 the ____

Account identified above for the full amount of services _________on 1st of every month or the next

business day.

These services are for: (check one) Personal Business

You, the Payor, may revoke your authorization at any time in writing, subject to providing notice of 30
days. To obtain a sample cancellation form, or for more information on your rights to cancel a PAD
Agreement, contact your financial institution or visit www.payments.ca

Signature(s) of Account Holder:

_________________________________ _______________________________
Name: (Please Print) KEN LEON DSOUZA Name: (Please Print)

Date:
27th April 2023
_________________________________

You have certain recourse rights if any debit does not comply with this agreement. For example, you have
the right to receive reimbursement for any debit 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
www.payments.ca

When this form is complete please return to:

whitehorsecondo.290@gmail.com