Secure Online Credit Card Payment

Set-up Pre-Authorized payment by Auto-Debit.
Please complete the following form and press SUBMIT

Please include all areas

CanWAN Account#:

ZZZ999

Daytime Phone #:

123-456-7890

Financial Institution:

Branch Address:

Full Name on Bank Account:

Transit Number (5 digits):

First 5 after Check Number

Institution Number (3 digits):

Next set after Transit Number

Account Number (12 digits):

Next set after Institution Number

Email Address:

Desired Transaction Day:

(1-28)

All information will be kept in full confidence.
You will recieve an email confirmation once the Auto-Debit information has been entered.

PLEASE NOTE

1) By completeing this form and pressing SUBMIT you authorize the full amount payable to CanWAN.com to be drawn by you on your financial institution on behalf of CanWAN.com

2) Your financial institution's treatment of each debit shall be the same as if you had personally directed the financial institution to pay as indicated and to charge the amount specified to your account.

3) Pre-authorized payments will be drawn on Canadian dollar accounts only.

4) You may apply to terminate this Auto-Debit Payment by contacting the CanWAN.com office in writing

Alternately you can mail a VOID check to our office
Please write "Auto Debit" in the Memo section, and sign the back

Set-up Pre-Authorized Payment on your Credit Card.
Please complete the following form and press SUBMIT

Please include all areas

CanWAN Account#:

ZZZ999

Daytime Phone #:

123-456-7890

Card Type:

Full Name on Card:

Card Number (16 digits):

Spaces between sets optional

Expiry Date (4 digits):

(MMYY) (MM/YY) Slash optional

Payment Type:

Desired Transaction Day :

(1-28) If Monthly payment selected

Payment Amount: $

If Single payment selected

Email Address:

All information will be kept in full confidence.

PLEASE NOTE

1) By completeing this form and pressing SUBMIT you authorize the full amount payable to CanWAN.com to be drawn by you on your financial institution on behalf of CanWAN.com

3) Pre-authorized payments will be drawn on Canadian dollar accounts only.

4) You may apply to terminate this Auto-CreditCard Payment by contacting the CanWAN.com office in writing