BANK OF MONTREAL PRE-AUTHORIZED DEBIT …



BANK OF MONTREAL PRE-AUTHORIZED DEBIT AUTHORIZATION

Re: Municipal Finance Authority of British Columbia – Municipal Investment Plan

We, the undersigned, hereby authorize the Bank of Montreal, 1225 Douglas Street, Victoria, BC, to utilize the following account for electronic funds withdrawals for the Municipal Finance Authority of British Columbia (the “Authority”). These withdrawals will be utilized to collect payroll deposits collected by the below listed regional district / municipality / and other eligible MFA Members from their employees who are members of the Municipal Investment Plan.

The amount and date of the bi-weekly electronic funds withdrawals will agree in detail to the payroll confirmation letter prepared by the authority and faxed / emailed to the MFA member two business days before the payment is due. The effective date of this authorization agreement will be the next occurring date for the bi-weekly withdrawals.

(Name of Regional District, Municipality, Regional Hospital District

and other eligible MFA members)

Address:

Phone: Fax: Contact E-mail:

Authorized Signatory:

Per: Print Name:

Per: Print Name:

Date:

Name of Bank:

Branch Address:

Account Name:

Transit Number: Account Number:

** Please include a void cheque when you return this form

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