Please complete the Pre-Authorized Debit (PAD) Plan agreement below.

    1. Customer Information (Please print clearly):

    2. Bank Account Information:

    3. Pre-Authorized Debit (PAD) Details

    You, the Payor, may revoke your authorization at anytime, subject to providing notice for 30 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit

    You have certain recourse rights if any debit does comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consitent with this PAD agreement. To obtain more information on your recourse rights, contact your financial institution or visit