Non Public Property (Npp) Payment Deduction Authorization (Pda) printable pdf download

Non Public Property (NPP) Payment Deduction Authorization (PDA)

Her Majesty The Queen in right o f Canada as represented by the Chief of the Defence Staff in his Non Public Property capacity through the Canadian Forces Personnel and Family Support

Services (CFPFSS)

Base

NPP Outlet

Account (UIEOS)

CFB Petawawa

Community Recreation

34150-

Last name (please PRINT)

First Name

Rank/Unit/Section

Date

Regular Force

Reserve

Service N

/ID N

OTHER -Specify

NPF Employee

PRI Number / SIN if

NPF Passport Number

civilian

(ME)

Address

City

Province

Postal Code

Telephone (home)

Telephone (business)

Email address

Date of Birth (Month/Day/Year)

(

)

(

)

Credit Card Number

Expiry Date (Month/Year)

CREDIT CARD TYPE - MASTERCARD / VISA / AMERICAN EXPRESS

Sub Total

PST/GST-HST

Total

Less Down Payment

Total Deduction Amount

Down Payment

Cash

Debit/Credit Card

Cheque

Amount of monthly Payment x # of Monthly Payments = Total Payment

These products and/or services are for (check one) Personal

Business Use

NPP PDA

Pre-Authorized Debit (PAD)

Military Pay Deduction

NPF Pay Deduction

Credit Card One payment

Plan

(Regular Force only)

(full time

per month on 30th

15th

One payment per month on the

Employees only)

(Provide credit card info or

or 30th

“same as above”)

30th

(Provide bank information below)

Option 1

Month & Year of First Withdrawal:

Monthly PDA Payment

Indefinite Term & Value

Month

Year

I hereby agree to pay the monthly PDA payment commencing the month specified herein, until such time as I advise CFPFSS in writing to cease such payment. I have read and

understand the terms and conditions of this contract.

Customer's signature

Option 2

Month & Year of First

Month & Year of Last

Monthly PDA Payment

Total Contract Value

Fixed Term & Value

Withdrawal:

Prélèvement mensuel

Montant total du contrat

Month :

Year :

I hereby agree to pay the monthly PDA payment commencing the month and year specified herein and monthly thereafter up to and including the last month in the year specified. I

have read and understand the terms and conditions of this contract.

Customer's signature/Signature du client

PRE-AUTHORIZATION FOR MONTHLY DEBIT

I hereby authorize CFPFSS to draw a monthly debit from my account, payable to CFPFSS, for payment to the NPP Outlet identified above. It is agreed that your

treatment of each debit and your rights with respect to it shall be the same as if it were authorized by the undersigned and that the failure to pay any such debit shall

give rise to no liability on your part. This authorization may be revoked on ten days written notice by the undersigned. 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 PAD that is not authorized or is not consistent with this

PAD Agreement. To obtain a Reimbursement Claim form, or for more information on your recourse rights contact your financial institution or visit

Bank Information (Must attach Blank Cheque marked VOID)

Financial Institution

Address

City

Province Postal Code

Branch N

Institution N

Account N

STAPLE VOID CHEQUE HERE

Void cheque may cover BANK information, but please make sure customer signature at the bottom is showing for photo copy.

Bottom of VOID CHEQUE not to go below this line.