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Please complete this form to have monthly fees automatically withdrawn from your account.
Please return this form with a scanned void cheque or bank information file.

Start Date: October 2021
End Date: May 2022

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

Payee Information

Payee 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 beginning October 2021 and ending May 2022.

We recommend that you retain a copy of this form for your records. Any charges incurred by Al Huda Islamic Center 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 payee 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: 100 MB.

Payee Signature*