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Pre-authorized Payment Form

Pre-authorized Payment (PAP)

Use the following form to pay your debt by pre-authorized payment (PAP):

By pressing send, I/we authorize Groupe Solution Collect and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions of the amount enter in the field « amount » for payment of all charges arising under my/our account(s) with Groupe Solution Collect. Regular monthly payments for the full amount will be debited to my/our specified account on the day of each month enter in the fill « date of first payment » . Groupe Solution Collect will obtain my/our authorization for any other one-time or sporadic debits.

This authority is to remain in effect until Groupe Solution Collect has received written notification from me/us of its change or termination. This notification must be received at least ten(10) business days before the next debit is scheduled at our head-office. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAP Agreement at my/our financial institution or by visiting

Groupe Solution Collect may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least 10 days prior written notice to me/us.

«I/We have certain recourse rights if any debit does not comply with this agreement. For example, I/We have the right to receive reimbursement for any PAP that is not authorized or is not consistent with this PAP agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution or »