Pre-Authorized Debit (PAD) Agreement
Thankyoufor your supportofthe UniversityofManitoba.
You haveindicated thatyouwishtomakea contributionthroughPre-authorizedDebit. Inorder to completethis process, theCanadianPaymentsAssociationrequires thatweprovideapre-authorized debitagreement.
Please printandfilloutthisformandreturnit,alongwithavoidcheque,to theUniversityof
Manitoba,Donor Relations, 200-137 Innovation Drive,Winnipeg,MB R3T2N2.
Pleasefilloutthesecondcopy ofthis form (below)for yourrecords. Oncewehavereceived your completed form, wewillprocessyour gift.
If youhaveanyquestionsor concerns, pleasecontactGift Processingat 204 474-9195.Thankyou.
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Pre-AuthorizedDebit(PAD)Agreement
Donor Name:
Pre-Authorized Debit (PAD) Agreement
TotalPledgeAmount: $
InstallmentSchedule: $ for months/ or ____on-going until further notice.
Pre-Authorized Debit (PAD) Agreement
Tobedirectedto(nameof fund)
Pre-Authorized Debit (PAD) Agreement
The debitwillbe processedto youraccountonthe10thday of eachmonthor thenextbusiness day.
Pre-Authorized Debit (PAD) Agreement
This donationismadeonbehalf of(pleasecheck): anindividual abusiness
Pre-Authorized Debit (PAD) Agreement
Informationforthedonor:
I mayrevokemyauthorizationatanytime,subjecttoprovidingnoticeof30days,bycontactingDonorRelationsat
204474-9195.Formoreinformationonmyrighttocancela PADagreement,I maycontactmyfinancialinstitution orvisit
I havecertainrecourserightsifanydebitdoesnotcomplywiththisagreement.Forexample,I havetherightto receivereimbursementforanydebitthatisnotauthorizedorisnotconsistentwiththisPADAgreement.To obtainmoreinformationonmyrecourserights,I maycontactmyfinancialinstitutionorvisit
Signature:_Date:
**Please CompleteandReturnAlongwithVoidChequeto:
Universityof Manitoba,DonorRelations
200-137 Innovation Drive, Winnipeg,MB R3T2N2
Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of processing your gift and updating your contact information with Alumni Relations and/or Donor Relations. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.
An official tax receipt will be mailed under Revenue Canada Taxation Reg. #11926-0669-RR0001.
For more information, contact Donor Relations:
Phone: 204.474.9195; Email: ; umanitoba.ca/giving
Pre-Authorized Debit (PAD) Agreement
Thankyou for your supportofTheUniversityofManitoba.
Youhaveindicated thatyouwishtomakea contributionthroughPre-authorizedDebit. Inorder to completethis process, theCanadianPaymentsAssociationrequires thatweprovidea pre-authorized debitagreement,asper below:
Pleasecompletethisform andretainitfor yourrecords.
Pleasecompletetheaboveformandreturnit along with avoidchequeto theUniversityof Manitoba, Donor Relations,200-137 Innovation Drive,Winnipeg,MB R3T2N2.Oncewe
havereceivedyourcompletedform,wewillprocess your gift.
If youhaveanyquestionsor concerns, pleasecontactGift Processingat 204474-9195.Thankyou.
------
Pre-AuthorizedDebit(PAD)Agreement
Donor Name:
Pre-Authorized Debit (PAD) Agreement
TotalPledgeAmount: $
InstallmentSchedule: $ for months/ or ____on-going until further notice.
Pre-Authorized Debit (PAD) Agreement
Tobedirectedto: (nameof fund)
Pre-Authorized Debit (PAD) Agreement
The debitwillbe processedto youraccountonthe10thday of eachmonthor thenextbusiness day.
Pre-Authorized Debit (PAD) Agreement
This donationismadeonbehalf of(pleasecheck): anindividual abusiness
Pre-Authorized Debit (PAD) Agreement
Informationforthedonor:
I mayrevokemyauthorizationatanytime,subjecttoprovidingnoticeof30days,bycontactingDonorRelationsat
204474-9195.Formoreinformationonmyrighttocancela PADagreement,I maycontactmyfinancialinstitution orvisit
I havecertainrecourserightsifanydebitdoesnotcomplywiththisagreement.Forexample,I havetherightto receivereimbursementforanydebitthatisnotauthorizedorisnotconsistentwiththisPADAgreement.To obtainmoreinformationonmyrecourserights,I maycontactmyfinancialinstitutionorvisit
Signature:_Date:
**Donor Copy–Please Retainfor your Records**
Notice Regarding Collection, Use, and Disclosure of Personal Information by the University
Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of processing your gift and updating your contact information with Alumni Relations and/or Donor Relations. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.
An official tax receipt will be mailed under Revenue Canada Taxation Reg. #11926-0669-RR0001.
For more information, contact Donor Relations:
Phone: 204.474.9195; Email: ; umanitoba.ca/giving