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Freedommobile Pap Form

This document outlines an auto pay debit agreement between a Freedom Mobile customer and the company. The customer provides their personal and bank account details to allow Freedom Mobile to automatically withdraw payments from their bank account by the due date on invoices. Key details include the customer's phone number, name, address, email, bank account number, branch and institution numbers. The customer agrees to the terms and conditions, including notifying Freedom Mobile of any changes, and signs and dates the form before returning it via mail, fax or email.

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Ibrahim El Amin
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© © All Rights Reserved
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535 views2 pages

Freedommobile Pap Form

This document outlines an auto pay debit agreement between a Freedom Mobile customer and the company. The customer provides their personal and bank account details to allow Freedom Mobile to automatically withdraw payments from their bank account by the due date on invoices. Key details include the customer's phone number, name, address, email, bank account number, branch and institution numbers. The customer agrees to the terms and conditions, including notifying Freedom Mobile of any changes, and signs and dates the form before returning it via mail, fax or email.

Uploaded by

Ibrahim El Amin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Auto Pay Debit Agreement

I’m a Freedom Mobile Postpaid customer and would like my monthly bill to be paid in full by the last payment
date noted on my invoice by way of Auto Pay. I understand that all Postpaid services under the same account
will be pre-authorized and the payment will be reflected on the invoice.

A Postpaid phone number on my Freedom Mobile account is: (______) ______ - ___________

STEP 1: PROVIDE PERSONAL INFORMATION (* Mandatory fields)

First name* __________________________ Last name* _____________________________

Unit #* _______ Street #* ___________________ Street Name* _____________________________

City* ______________________ Province* __________ Postal Code* _____________

Email* ________________________________________________

STEP 2: PROVIDE BANK ACCOUNT DETAILS (* Mandatory fields)

Cheque # ________ Transit #* _______ Institution #* _______ Account #* ___________________


(No dashes required)

Please fill in the above information exactly as it’s shown in the cheque example below. An unsigned cheque
marked VOID must be included for verification.

Signature Bank Stamp Here

If you are attaching a void cheque, bank confirmation is not required.

TERMS & CONDITIONS

Have any questions? Want to cancel/revoke this


agreement or make some changes? Please contact us at
1-877-946-3184 or 611 from your Freedom Mobile phone.
Please allow at least 5 working days for these changes.

If you’re changing your bank account, phone number, or


doing any other major changes to your account like
switching ownership you’re obliged by this agreement to
inform Freedom Mobile and cancel your Auto Pay Debit
Agreement. Please allow at least 5 working days for these
changes.

You have certain recourse rights if any debit does not com-
ply 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 personal Auto Pay Debit
Agreement. To obtain more information on your recourse
rights contact your financial institution or visit www.cdnpay.ca.
Auto Pay Debit Agreement

STEP 3: SIGN HERE

I’ve read and understood the terms and conditions of this authorization. I acknowledge that I’ve received a copy
to keep.

Signature(s)* _______________________________________________________

Date* _________________

(*For joint accounts, all account holders must sign if more than one signature is required on cheques issued
against the account)

STEP 4: RETURN THIS FORM TO US BY MAIL, FAX OR EMAIL

Mail to: Freedom Mobile, 200-3671 Uptown Boulevard, Victoria, B.C. V8Z 0B9
Fax to: 1 (866) 418-4145
Email scanned copy to: backoffice@freedommobile.ca

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