PRE-AUTHORIZED PAYMENT FORM
Setting up pre-authorized payment is fast, easy – and convenient! Simply review the Terms and Conditions below, complete this authorization form, and attach a “VOID” check. Head Office or Landlord Name
Bank Account Holder
Co-Account Holder (if, applicable)
Address
Financial Institution
Financial Institution Number
Branch-Transit Number
Bank Account Number
REQUEST FOR PRE-AUTHORIZED PAYMENTS I hereby authorize _________________________ (hereinafter referred to as the "Company") and/or to debit the account of the undersigned maintained with the financial institution indicated above, monthly, in accordance with the payment authorization below, for the purpose of paying monthly rentals as noted above. Please be advised that the Rent provided for in the Lease is the Rent payable by the Tenant during the Term of the Lease, including the increases from time to time, in accordance with the relevant provisions of the Lease. Also, the Tenant authorizes the Landlord to pay all invoices for Additional Rent, as defined in the Lease, including the thirteenth (13th) invoice relating to the adjustments of Operating Costs and Real Estate Taxes, which invoices have not been contested by the Tenant, within fifteen (15) days of receipt, or upon terms and conditions stipulated in the lease "Please enclose an unsigned sample cheque from your financial institution" Signed on_________________________________________________20__________________ __________________________
Head Office 630 Saint-Paul Street West, Suite 600 Montreal, Quebec H3C 1L9 T. 514-374-6224
_________________________ Authorized signature(s) 1