Pre-authorized Remittance On-line Form |

First Baptist Church

Please fill out the form below and click the “Submit” button.
OR
Download, print and fill out the PAR Agreement Form and send to the church.

Date *

YYYY/MM/DD

Envelope #

(optional)

I hereby request and authorize First Baptist Church Regina Inc., . . . 2241 Victoria Ave, Regina SK *

First

Last

to debit my account: *

monthly on the 6th day of each month
I will contact the Treasurer as I wish to have the transfer occur on a different day of the month
I will contact the Treasurer as I wish to have the transfer occur more than once per month

in the amount of *

$ amount per remittance

starting on the 6th of *

General

(optional distribution of funds ... $ amount to be allocated to General Funds)

Other

(optional distribution of funds ... $ amount to be allocated to other funds. Please specify below:)

Other

Branch/Transit No, *

Usually 5 or more digits

Bank/Institution No. *

3 digits

Account No. *

Personal account number

If you are unsure about the above bank information, please take a picture of a VOID cheque and send to

Legal Information

I may change the amount of my contribution at any time subject to providing notice of 30 days.
I may revoke my authorization at any time, subject to providing notice of 30 days at which time I will submit a cancellation form obtained from my church’s PAR Contact, by contacting my financial institution or by visiting www.cdnpay.ca
I have certain recourse rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this pre-authorized remittance agreement. To obtain more information on my recourse rights, I may contact my financial institution or visit www.cdnpay.ca
I waive my right to receive pre-notification of the amount of the pre-authorized remittance and agree that I do not require advance notice of the amount of pre-authorized remittance before the debit is processed.
The use, retention and disclosure of personal information collected from this form is done in compliance with privacy legislation, including but not limited to, the Personal Information Protection and Electronic Documents Act (S.C. 2000, c. 5)