HCSI - PAP Enrollement Form - RNC

Pre-Authorized Payment (PAP) Enrollment Form

HCSI Home Comfort is the supplier of your high-efficient water heating equipment, as outlined in your Agreement of Purchase and Sale.

Please complete the form below by providing your pre-authorized payment banking or credit card information prior to the closing date of your new home.

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Cell Phone *

Home Phone (If applicable)

Email Address*

BILLING OPTIONS

Billing Options*

PAP Credit Card

Transit (5 Digits)*

Bank Number (3 Digits)*

Account*

Name On Card*

Credit Card Number*

Credit Card Expiry (Month)*

Credit Card Expiry (Year)*

CVV*

Please attach a copy of your void cheque*

No File Chosen

File uploads may not work on some mobile devices.

Please attach a copy of your documentation indicating your closing date

No File Chosen

File uploads may not work on some mobile devices.

I authorize HCSI Home Comfort Inc. to process payment for my HVAC equipment in accordance with the equipment lease.