Registration Form

monthly giving pre-authorized debit (PAD) Payment service agreement

First Name

Last Name

Address

City

Province

Postal Code

Phone

Branch Transit

Institution

Account No.

Amount

You can increase, decrease, cancel or put on hold your donation at any time. Simply let us know if you would like to make a change to your recurring gift. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit 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 payments.ca.

I authorize Indwell to deduct the amount specified from my bank account on or around the 15th of every month, and I accept the terms of Indwell’s pre-authorized debit agreement above.

New Form

Donor Information
- First Name:
- Last Name:
- Email:
- Address:
- City:
- Province:
- Postal Code:
- Phone:
Bank Information
- Branch Transit:
- Institution:
- Account No.:
Payment Details
- Amount:
- agreement:

Indwell 1430 Main St E, Hamilton, ON L8K 1C3 info@indwell.ca 1-866-529-0454

Registration Form

monthly giving pre-authorized debit (PAD) Payment service agreement

New Form

Donor Information

Bank Information

Payment Details

Send a note of encouragement