* Pre-Authorized Payment – PAP Form – Al Huda Elementary School

Mandatory Automatic Fee Withdrawal Form

Please complete this form to have monthly fees automatically withdrawn from your account.

Student Name #1

First Last

Grade #1*

Student Name #2

First Last

Grade #2

Student Name #3

First Last

Grade #3

Student Name #4

First Last

Grade #4

Payer Information

Payer Name*

First Last

Parent Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City Province Postal Code

Select the withdrawal day of the month*

Consent*

I (we) authorize Al Huda Islamic Center of Canada to process a debit, in paper, electronic, or another form in the fixed amount (provided by Al Huda Elementary) on my (our) account on or after the above selected day of each month.*

We recommend that you retain a copy of this form for your records. Any charges incurred by Al Huda Islamic Centre of Canada Inc. due to insufficient funds at the time of withdrawal and/or other fees charged related to the automatic withdrawal of funds for the purpose of fee payment are the sole responsibility of the payer and will be passed on as such.

Please upload your scanned void cheque or bank account information*

Accepted file types: jpg, png, pdf, doc, Max. file size: 2 MB.

Payer Signature*

* Pre-Authorized Payment – PAP Form

Pre-Authorization Payment - PAP Form

Mandatory Automatic Fee Withdrawal Form

Payer Information