POSTPAID PAD-FRONT-EN - Virgin Mobile Canada

PRE-AUTHORIZED DEBIT WITH VIRGIN MOBILE<br />

SO YOU’RE READY TO BANK IT.<br />

By hooking up direct debit from your<br />

bank account we can do all the work of<br />

paying the total that’s due on your<br />

monthly bill. Well, not us personally, but<br />

our computers…you get the idea.<br />

JUST A QUICK REFRESH:<br />

Each month, 21 days after your bill date, we’ll take the total due on your bill directly from your bank account and apply it to your<br />

<strong>Virgin</strong> <strong>Mobile</strong> account .<br />

Now just follow these 3 easy steps and you’re good to go:<br />

1 FILL OUT THIS SNAZZY LITTLE FORM.<br />

YOUR DEETS<br />

FULL NAME<br />

CONTACT TELEPHONE #<br />

VIRGIN MOBILE ACCOUNT #<br />

VIRGIN MOBILE CELLPHONE #<br />

HOME ADDRESS<br />

CITY PROVINCE POSTAL CODE<br />

E-MAIL ADDRESS<br />

YOUR BANK DEETS<br />

NAME OF ACCOUNT HOLDER<br />

BANK NAME<br />

TRANSIT CODE<br />

BANK CODE<br />

ACCOUNT NO.<br />

BANK ADDRESS<br />

(5 DIGITS)<br />

(3 DIGITS)<br />

(7 DIGITS)<br />

TRANSIT CODE SAY WHAT<br />

No sweat – you can find your transit or bank code at the bottom of one of your cheques.<br />

Check out the example<br />

2 S<strong>EN</strong>D IT BACK TO US – AND A VOID CHEQUE IF YOU HAVE A CHEQUING ACCOUNT.<br />

THERE ARE THREE WAYS YOU CAN S<strong>EN</strong>D THE COMPLETED FORM BACK TO US:<br />

1. Email it to bankit@virginmobile.ca (be sure to include a scan of this original signed form and a scan of your voided cheque)<br />

2. Fax it to 1.888.991.0012<br />

3. Snail Mail it to Bank it, <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> – PO Box 6360 STA A, Toronto ON M5W 1P7<br />

3 KICK BACK & RELAX.<br />

Once we process your form we’ll leave you a message on your cell phone voicemail letting you know that everything is cool,<br />

as well as the date of your next scheduled monthly withdrawal from your bank account. Told you it would be easy.

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PRE-AUTHORIZED DEBIT WITH VIRGIN MOBILE<br />

SOME LEGAL STUFF YOU<br />

NEED TO AGREE TO...<br />

THIS SIGNED FORM IS YOUR COPY OF YOUR AUTHORIZATION.<br />

Please keep it for your reference. If you have insufficient funds in your account for a withdrawal then we will reverse any funds credited to your<br />

<strong>Virgin</strong> <strong>Mobile</strong> account. We will also attempt to contact you to make alternate payment arrangements. If we are unable to reach you, your<br />

outbound calls may be redirected into our collections department to discuss payment arrangements. It is your responsibility to contact our<br />

offices with a payment arrangement to avoid possible temporary and permanent disconnection of your service. You are responsible for any<br />

early Cancellation Fees resulting if your service is permanently disconnected prior to the end of your Membership Term.<br />

You can make changes to or withdraw from the Bank It Pre-Authorized Debit (“<strong>PAD</strong>”) program anytime you like, just as long as you’ve notified<br />

<strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> at least 10 days in advance of the next scheduled monthly withdrawal. <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> will credit your bank<br />

account in the event it is ever debited incorrectly, in accordance with the <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> Terms and Conditions of Service. <strong>Virgin</strong> <strong>Mobile</strong><br />

<strong>Canada</strong> only collects uses and discloses Personal Information that you supply in order to provide you with the services you have requested<br />

and, if so elected by you, to provide you with further information on offers and services. For more information about the <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong><br />

Privacy Policy and our Terms and Conditions of Service, including Cancellation Fees, visit our website at www.virginmobile.ca.<br />

YOU AUTHORIZE<br />

By signing this form I confirm that:<br />

I have read and understand the terms & conditions of this authorization and acknowledge receipt;<br />

I understand that I will not receive notification of the amount to be withdrawn each month other than my bill. Therefore, I expressly<br />

waive any legislative or regulatory requirement for pre-notification of the amount to be withdrawn from my account;<br />

I authorize <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> and Royal Bank of <strong>Canada</strong> to deduct a <strong>PAD</strong> amount which is equal to the total due on my bill directly<br />

from my bank account each month as per these terms & conditions;<br />

I agree that a facsimile of my signature may be used to evidence my acceptance of this Agreement;<br />

I will notify <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> of any changes to my <strong>PAD</strong> account, in my banking information or my request to terminate at least ten<br />

(10) days prior to the next withdrawal date;<br />

I confirm that all persons who are required to sign on this bank account have signed below; and<br />

I agree that my personal information may be used by <strong>Virgin</strong> <strong>Mobile</strong> <strong>Canada</strong> in accordance with its Privacy Policy.<br />

For joint accounts, if more than one signature is required on cheques issued on the account, then all holders of the account must sign this form.<br />

I acknowledge that I have read and understand the Terms and Conditions of the Pre-Authorized Debit program and agree to these terms.<br />

Signature<br />

Signature<br />

Date<br />

Date<br />

DD/MM/YYYY<br />

DD/MM/YYYY<br />

QUESTIONS<br />

GIVE US A SHOUT AT<br />

1.888.999.2321<br />

www.virginmobile.ca