I, the undersigned (if a legal entity, represented here by its duly authorized representative(s)), authorize AGENCE UNION PPC S.E.N.C. and my financial institution to execute preauthorized debits (PAD) from my account with the above-designated financial institution or to charge my credit card in order to automatically pay the balance of my monthly statement, all on a monthly basis.

Each withdrawal will correspond to a fixed amount, which may be increased without further authorization from me, provided that AGENCE UNION PPC S.E.N.C. sends me written notice at least 10 days before the due date of the modified payment. This authorization is valid for any service billed by AGENCE UNION PPC S.E.N.C. This constitutes a business PAD.


I acknowledge receipt of a copy of this agreement and waive any confirmation prior to the first payment. I understand that administrative fees of $45.00 will be charged to my account for returned or declined payments.

Change or Cancellation

I will inform AGENCE UNION PPC S.E.N.C. in writing of any changes related to bank or credit card information before the date of the next automatic withdrawal. I can revoke this PAD authorization at any time, with a notice of thirty (30) calendar days to AGENCE UNION PPC S.E.N.C. To obtain a specimen cancellation form or for more information on my right to cancel a PAD agreement, I can contact my financial institution or visit the Canadian Payments Association website at www.payments.ca. I release the financial institution from any liability if the revocation is not respected, unless it is due to gross negligence on its part.

I agree that the financial institution where I have my account is not obliged to verify that the payment is withdrawn according to my authorization. I attest that all persons whose signatures are required for the operation of the account identified above have signed this authorization. I also acknowledge that submitting this authorization to AGENCE UNION PPC S.E.N.C. is equivalent to submitting it to the financial institution indicated above.


I have certain recourse rights if a debit is not in accordance with this agreement. For example, I have the right to receive reimbursement for any PAD that is not authorized or that is not consistent with this PAD agreement. For more information on recourse rights, I can contact my financial institution or visit www.payments.ca.

The financial institution will reimburse me, on behalf of AGENCE UNION PPC S.E.N.C., for amounts incorrectly withdrawn within 10 business days of the withdrawal for a business PAD, provided the reimbursement is requested for a valid reason.

Consent to Information Sharing

I consent to the information contained in my PAD membership application being shared with the financial institution, to the extent that this sharing of information is directly related and necessary for the proper implementation of the applicable rules for preauthorized debits.

AGENCE UNION PPC S.E.N.C. reserves the right to terminate my enrollment in the automatic withdrawal program at any time, upon sending a written notice of forty-five (45) days. I acknowledge having received a copy of this authorization and having read the attached terms. I consent to my/our handwritten signature being used to attest to my/our acceptance of this agreement.