Download Bell EXPRESSVU Installation guide

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5/18/05
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Page 61
Installation and Setup
Pre-Authorized Payment Plan
CANCELLATION
• This agreement can be terminated, upon written notification, at any time, by
the customer or Bell ExpressVu. Your notification must be received in our
offices at least 14 days prior to your next invoice date.
• Upon termination of the pre-authorized payment plan, any amount owing
will be paid directly to Bell ExpressVu.
• We require a minimum of 14 days to process your cancellation request.
“ExpressVu” is a registered trademark held by Bell ExpressVu Inc. “Bell” is a registered trademark of Bell Canada and is used under license.
Bell ExpressVu Pre-Authorized Payment Plan
For the convenience of pre-authorized payments, please complete this
form and send it with a void cheque to Bell ExpressVu at the address
indicated below:
I hereby authorize Bell ExpressVu to withdraw monthly, from my financial institution, the amount
due on my Bell ExpressVu Statement. I acknowledge that the withdrawal will occur approximately
twenty (20) days after the billing date on my Bell ExpressVu statement. I understand that Bell
ExpressVu does not charge for this service although my bank or trust
company may. This authority is to remain in effect until I notify Bell ExpressVu, in writing,
Attention: Billing Department, 115 Scarsdale Road, North York, ON, M3B 2R2 or by Fax at
(416) 382-5833, or until Bell ExpressVu notifies me in writing. I acknowledge that I am aware
of all the terms and conditions that Bell ExpressVu has listed.
PERSONAL INFORMATION
Your Name:
PLEASE PRINT YOUR NAME AS IT APPEARS ON YOUR STATEMENT
Telephone Number: (
)
Bell ExpressVu Account:
8455-
Alternate Telephone Number: (
)
Address:
ADDRESS
APT. # OR P.O. BOX #
CITY/TOWN
PROVINCE
POSTAL CODE
BANKING INFORMATION
Name of your financial institution:
Account Number:
Transit Number:
Telephone Number: (
)
PROVINCE
POSTAL CODE
Address:
STREET ADDRESS
CITY/TOWN
PLEASE ATTACH AN UNSIGNED CHEQUE MARKED “VOID”
TO THE COMPLETED AGREEMENT.
AUTHORIZED SIGNATURES*
Signature
Date
NAME (PLEASE PRINT CLEARLY)
Signature
Date
NAME (PLEASE PRINT CLEARLY)
*All signatures are required for accounts with joint signatures.
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