Pre-Authorized Debit Form

PRE-AUTHORIZED DEBIT (PAD) AGREEMENT 1. I/We hereby authorize Salt Spring and Southern Gulf Islands Community Services Society, DBA Island Community Services (ICS) to debit my account monthly, covering monthly rental and other fees due by the undersigned ICS. This amount may be increased/decreased as required by the change in monthly rental and other amounts, provided such increases are agreed to or are made in accordance with provisions of the Residential Tenancy Act. All pre-authorized payments will be made on the first of the month. 2. In accordance with (1.) above, I do hereby waive my right to receive pre-notification of the amount of the PAD and agree that I do not require advance notice of the amount of the PAD before the debit is processed. 3. I hereby authorize ICS to debit my account monthly for additional charges for: Parking Other _________________ 4. I understand the personal information provided is for purposes of identifying and communicating with me, processing payments, responding to emergencies, and ensuring the orderly management of the Property and complying with legal requirements. I hereby authorize ICS to collect, use and disclose my personal information for these purposes. 5. The account that ICS is authorized to draw upon is indicated below. 6. I undertake to inform ICS of any change in the account or address information provided in this authorization as soon as the change occurs. 7. This authorization may be cancelled at any time upon 15 days written notice to ICS. 8. I acknowledge that delivery of this authorization to ICS constitutes delivery by me to the above financial institution. 9. I acknowledge that I have certain recourse rights if any debit does not comply with this agreement.