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Submission information
Form:
9. Pre-Authorized Debit (PAD) Plan agreement
Submitted by
Freddie Chow
Fri, 04/14/2023 - 15:41
142.167.250.240
Name(s)
Freddie Chow
Date
Fri, 04/14/2023
Address*
62 Jumper Lane
City*
Hammonds Plains
Province
Nova Scotia
Postal Code*
b4b0g9
Phone (Bus.)
Phone (Res.)
Phone (Cell)
9024016542
Name and Branch*
TD Band 287 Lacewood Drive
FI Account Number*
6247715
FI Transit Number (branch – 5 digits; FI – 3 digits)*
54233 - 004
Account Type
Chequing
Branch Address*
278 Lacewood Drive
City*
Halifax
Province*
Nova Scotia
Postal Code*
b3m 3n8
Authorized Signature(s)*
Freddie Chow
Fri, 04/14/2023 - 15:40
Email Address*
f.chow@eyesonoptometrygroup.com
Child(ren)’s Name(s):
Niamiah Beaman-Delaney, Bennett Copw
Please upload a copy of a VOIDED cheque on the above named account.
PDF document-0FD7CF735D3A-1.pdf
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