This document outlines a pre-authorized payment plan for a membership at Masjid Al Fatima. It requests applicant information including name, contact details, and banking information to set up automatic monthly payments. Applicants must provide either a void cheque or pre-authorized form and agree to the terms and conditions. Payments will be automatically deducted each month until either party terminates the agreement. Additional notes specify that all major banks participate, applicants should review billing statements, and sufficient funds must be available on payment dates to avoid fees.
This document outlines a pre-authorized payment plan for a membership at Masjid Al Fatima. It requests applicant information including name, contact details, and banking information to set up automatic monthly payments. Applicants must provide either a void cheque or pre-authorized form and agree to the terms and conditions. Payments will be automatically deducted each month until either party terminates the agreement. Additional notes specify that all major banks participate, applicants should review billing statements, and sufficient funds must be available on payment dates to avoid fees.
This document outlines a pre-authorized payment plan for a membership at Masjid Al Fatima. It requests applicant information including name, contact details, and banking information to set up automatic monthly payments. Applicants must provide either a void cheque or pre-authorized form and agree to the terms and conditions. Payments will be automatically deducted each month until either party terminates the agreement. Additional notes specify that all major banks participate, applicants should review billing statements, and sufficient funds must be available on payment dates to avoid fees.
This document outlines a pre-authorized payment plan for a membership at Masjid Al Fatima. It requests applicant information including name, contact details, and banking information to set up automatic monthly payments. Applicants must provide either a void cheque or pre-authorized form and agree to the terms and conditions. Payments will be automatically deducted each month until either party terminates the agreement. Additional notes specify that all major banks participate, applicants should review billing statements, and sufficient funds must be available on payment dates to avoid fees.
First Name (Please Print) Last Name (Please Print) Contact Telephone Number
First Name (Please Print) Last Name (Please Print) Contact Telephone Number
2. BANKING INFORMATION
What type of banking account will your monthly memeber ship payments be withdrawn from?
Personal Business
Are your providing a void cheque or pre-authorized form obtained from your financial institution with this application?
Void Cheque Pre-Authorized Form
3. PAYMENT INFORMATION
I/We authorize the Masjid Al Fatima to debit my(our) account as indicated on the attached banking information. This authority will remain in effect until I/We or the Masjid Al Fatima notify the other of termination.
4. APPLICANT SIGNATURE I/We agree to the terms and conditions outlined on the back of this form
Signature Date .
Signature Date ADDITIONAL INFORMATION
• All banks are participating
• If your amount is not correct contact the office as soon as possible. We will review your billing statement and make necessary adjustments prior to the pre-authorized payment being applied. • Please note that your payment will be deducted early the morning of the due date. Therefore, sufficient funds or bank approved overdraft protection must be available at the time to avoid non-sufficient funds (NSF) or returned payment charges.
