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Submission information
Form:
9. Pre-Authorized Debit (PAD) Plan agreement
Submitted by
Anonymous (not verified)
Sun, 02/26/2023 - 19:55
142.67.130.4
Name(s)
John Smith
Date
Address*
14 Blue Forest Lane
City*
Halifax
Province
Nova Scotia
Postal Code*
B4B 1L1
Phone (Bus.)
Phone (Res.)
Phone (Cell)
Name and Branch*
TD Bank
FI Account Number*
1998190u7w0
FI Transit Number (branch – 5 digits; FI – 3 digits)*
1123
Account Type
Chequing
Branch Address*
55 Bedford Hwy
City*
Bedford
Province*
Nova Scotia
Postal Code*
B3L 2J6
Authorized Signature(s)*
John Smith
Sun, 02/26/2023 - 19:54
Email Address*
stay@blueforest.ca
Child(ren)’s Name(s):
Kim Smith
Please upload a copy of a VOIDED cheque on the above named account.
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