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Please use the sample cheque below to find the information on your own cheque to enter the data needed in the form below to process your monthly pledge.
Type of Account? Choose One.
Branch Number (5 Digits - See Sample)
Institution Number (3 Digits - See Sample)
Amount of monthly donation?
If you choose OTHER above, please fill in amount here.
Type of Pre-Authorized Debit? Choose one.
Payment frequency can be the 1st or 16th of each month. Choose one.
Payments will start on the nearest date once form is submitted.
If you have any questions, please contact the YFC Canada offices at 1.800.899.9322 or email email@example.com
Thank you for your support.
Your Payor's Pre-Authorized Debits (PADs) agreement may be cancelled provided notice is received thirty (30) days before the next scheduled PAD. If any of the above details are incorrect, please contact us immediately at
. If the details are correct, you do not need to do anything further and your Pre-Authorized Debits will be processed and start on the payment start date indicated in the form you completed which will either the 1st or 16th of each month.
You have certain recourse rights if any debit does not comply with these terms. For example, you have the right to receive a reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit Canadian Payments Association at
Payor's Acceptance and Authorization.
I/We, by selecting "YES" and submitting this form, authorize Youth for Christ / Canada (the Payee) to issue PADs (as defined in CPA, Rule H1) drawn on the above account in accordance to the "Terms and Conditions" of the Pre-Authorized Agreement for the agreed upon amount on a monthly basis.
Youth for Christ / Canada (YFC Canada)
Thank You For Supporting Naomi!
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Youth for Christ Canada
#308 – 8047 199 Street
Langley, British Columbia
V2Y 0E2, Canada
Toll Free: 1-800-899-9322
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