PRE-AUTHORIZATION AGREEMENT

TENANT INFORMATION
First Name *

Last Name *

Email *

Telephone *

Address *

Unit Number *

City *

Postal *

Country *

FINANCIAL INSTITUTION
Bank Name *

Branch *

Account Number *

Amount Authorized *

Void Cheque

I agree to the following terms & conditions:*

You confirm that you are the authorized representative of the contract and the account and also hereby acknowledge the authorization and acceptance of any Joint Account Holder related to the information provided herein. You the payor authorize Anna Moore Realty Inc. to debit the bank account identified herein for the amount provided herein each time that the value of the services you have purchased, including applicable taxes, reaches that amount. You the payor may revoke your authorization at any time in writing (by letter or email) subject of providing notice of 30 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution. You have a certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution. Anna Moore Realty Inc. 196 Blake Street L4M 1K3 Barrie Ontario 705-728-6496