UMS’ Monthly PRE-AUTHORIZED PAYMENT FORM

We are pleased to offer pre-authorized payment for monthly payments at Unionville Montessori School starting September
1st 2021. This payment procedure is simple and easy for both you and the School! All you have do is the following:
ü Complete and sign the authorization form(s) for each student enrolled – ONLY ONE FORM PER STUDENT
ü Attach one blank cheque marked “VOID” to the form(s)
ü Return Pre-Authorized Payment Form with a void cheque & a separate cheque with the deposit fee [Month
of June Fee, book fee, and technology fee (elementary only)]

If you have any questions please contact us at office@unionvillemontessori.com or 905.474.9888

1. Student(s) Information:

i) Students Name: Monthly Fee: $

Program: ¨ Elementary ¨ Sr. Casa ¨ Pre/ Jr. Casa Full Day ¨ Pre/Jr. Casa Half Day

2. Bank Account Information *PLEASE ATTACH VOID CHEQUE*

Branch Transit Number:________________ (5 digits) Account Type: Chequing

Financial Institution Number: _____________(3 or 4 digits) mark with [X] Savings
Bank Account Number:__________________________
Financial Institution Name:
Financial Institution Address:

3. Pre-Authorized Debit (PAD) Details (signatures are required by both account owners for joint accounts)

I/we authorize Unionville Montessori School (hereafter referred to as “UMS”)to debit, in paper, electronic or other form

the bank account identified above as per my/our instructions for monthly recurring payments in the amount of

$_______________________ on the 1st day of each month (or the next business day) beginning in September 2021 and with

the final payment on the 1st day (or the next business day) of May 2022.

I/ we acknowledge that I/we have read, understood and accepted all the provisions contained in the Pre-
Authorized Payment Authorization Terms & Conditions and that I/we have retained a copy for our records.

I/We warrant and guarantee that all persons whose signatures are required to sign on this account have signed
this agreement.

Signature of Bank Account Holder: Signature of Joint Bank Account Holder (if applicable):

Name (printed) : Name (Printed) :

Date: Date:

Unionville Montessori Private School ♦ 4486 16th Avenue, Markham, ON L3R 0M1 ♦ 905.474.9888 ♦
office@unionvillemontessori.com
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 UMS’ Monthly PRE-AUTHORIZED PAYMENT FORM

PRE-AUTHORIZED PAYMENT AUTHORIZATION - TERMS AND CONDITIONS:

I/We acknowledge and understand that this agreement constitutes a personal PAD agreement and
authorization.

I/We acknowledge that this Authorization is provided for the benefit of UMS and is provided in consideration of
my financial institution agreeing to process debits against my account in accordance with the Rules of the
Canadian Payments Association.

I/We understand that pre-authorized debits that are returned due to insufficient funds will be subject to a $50
NSF charge on my/our child’s account.

I/We authorize UMS to debit my/our account that if I/we incur a charge from UMS which includes but is not
limited to the aforementioned NSF charge, Late Pick-Up fee, iPad Repair fee, unpaid afterschool program/
enrichment fee, and any other outstanding or unpaid fees. I authorize the amount of the charge to be added
to the Pre-Authorized Debit (PAD) amount for a scheduled payment following the date of the charge. I/We will
be notified if said fees are to be charged to my account. If I incur any charge in June 2022 after the last
scheduled payment has been processed, I permit an additional pre-authorized debit payment to be
processed on the 1st day or the next business day of July 2022 to cover the charges.

I/We acknowledge that provision and delivery of this authorization to UMS constitutes delivery to my financial
institution.

I/We and UMS mutually agree to waive the pre-notification requirements set out in Section 15(a) and 15(b) of
Rule H1 of the Canadian Payments Association.

The account that UMS is authorized to draw upon is indicated in the accompanying authorization. A
specimen cheque for this account has been marked "VOID" and attached hereto.

I/We acknowledge that a financial institution is not required to verify that a PAD has been issued in accordance
with the particulars of my/our Authorization including, but not limited to, the amount.

I/We undertake to inform UMS, in writing, of any change in the account information provided in this
authorization thirty (30) days prior to the next due date of the PAD.

I/We may revoke this authorization at any time by providing UMS with written notification of its change or
termination. This notification must be received at least thirty (30) business days before the next debit is
scheduled at the school address provided below. I/We understand that I/we may obtain a sample
cancellation form, or further information about cancelling a PAD Agreement at my/our financial institution or
by visiting www.payments.ca.

Revocation or cancellation of this authorization does not terminate any contract for goods or services that
exists between myself/ourselves and UMS. This Authorization applies only to the method of payment and does
not otherwise have any bearing on the contract for goods or services exchanged.

I/We understand that 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 debit that is not authorized or is not consistent
with this PAD Agreement. To obtain more information on my/our recourse rights, I/we understand that I/we may
contact my/our financial institution or visit www.payments.ca.

Unionville Montessori Private School ♦ 4486 16th Avenue, Markham, ON L3R 0M1 ♦ 905.474.9888 ♦
office@unionvillemontessori.com
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