Direct debit Canada

Set up direct debit

Instructions: please complete all sections on this form to notify your banking institution that you authorize UNIFORM-Agri to collect your invoice payments directly from your bank account.

"*" indicates required fields

1. Customer information

Name:*

Address:*

City:*

Postal code:*

Province:*

Phone Number:*

E-mail:*

2.Banking information

Account Number:*

(between 7 & 12 digits)

Transit Number:*

(5 digits)

Branch Number & Name:*

Date:*

Name

This field is for validation purposes and should be left unchanged.