The ACH Payment Authorization Form (known in Canada as EFT or Pre-Authorized Debit Authorization) is a fundamental document used to establish automated payment arrangements between parties. This form is essential when a business or organization needs to collect regular payments from customers, or when individuals want to set up automated bill payments. The document must comply with Canadian Payments Association Rules, particularly Rule H1 governing pre-authorized debits, and include specific elements required by Canadian banking regulations. It contains detailed information about both parties, banking details, payment terms, and mandatory disclosures about privacy, cancellation rights, and recourse procedures. The form serves as a legal authorization for the transfer of funds and provides protection for both the payor and payee under Canadian law.
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1. Form Title and Date: Clear identification of the document as an EFT/Pre-Authorized Debit Authorization Form with date
2. Payor Information: Complete details of the account holder including full legal name, address, phone number, and email
3. Financial Institution Information: Payor's bank details including institution name, transit number, institution number, and account number
4. Payee Information: Company/organization receiving the payments, including legal name, address, and contact information
5. Payment Details: Specification of payment amount, frequency (one-time vs recurring), and start date
6. Authorization Statement: Clear statement of authorization including the scope of the authorization and acknowledgment of terms
7. Cancellation Rights: Statement of the payor's right to cancel the authorization and required notice period
8. Recourse Statement: Information about the payor's recourse rights and reimbursement options
9. Signature Block: Space for payor's signature, printed name, and date
1. Variable Payment Authorization: Additional authorization section for variable payment amounts, required when payment amounts may fluctuate
2. Joint Account Authorization: Additional signature section when the bank account requires multiple authorizations
3. Electronic Communication Consent: Optional consent for receiving electronic communications about the payments
4. Business PAD Agreement: Additional terms specific to business accounts, used when the payor is a business entity
5. Payment Change Authorization: Section authorizing future changes to payment amount with notice, useful for recurring service payments
1. Void Cheque or Direct Deposit Form: Attachment of void cheque or bank-issued direct deposit form to verify account details
2. Payment Schedule: Detailed schedule of payment dates and amounts (for fixed recurring payments)
3. Terms and Conditions: Detailed terms and conditions of the pre-authorized debit arrangement
4. Privacy Notice: Detailed privacy policy regarding the handling of personal and financial information
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