Wellington North Power

Pre-Authorized Payment Agreement Form

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I/We authorize Wellington North Power Inc., and the financial institution designated (or any other financial institution I/we may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one-time payments from time to time, for payment of all charges arising under my/our Wellington North Power Inc. account(s). Regular monthly payments for the full amount of services delivered will be debited to my/our specified account on the date under “1.5% Interest After”. Wellington North Power Inc. will provide your bill as ten (10) days written notice of the amount of each regular debit. Wellington North Power Inc. will obtain my/our authorization for any other one-time or sporadic debits.

This authority is to remain in effect until Wellington North Power Inc. has received written notification from me/us of its change or termination. This notification must be received at least ten (10) business days before the next debit is scheduled at Wellington North Power Inc., 290 Queen Street West, PO Box 359, Mount Forest, ON N0G 2L0. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD Agreement at my/our financial institution or by visiting www.cdnpay.ca.

Wellington North Power Inc. may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least ten (10) days prior written notice to me/us. I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/we have the right to receive reimbursement for any PAD that is not authorized or is not consistent with this PAD Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/we may contact my/our financial institution or visit www.cdnpay.ca.