Monthly Credit Card Authorization

Set-up Pre-Authorized Payment on your Credit Card.
Note: This option does not qualify for the $5 month discount.
Complete the following form and press SUBMIT.
Please fill in all areas of the form.

CanWAN Account #:
Daytime Phone #:
Card Type:
Full Name on Card:
Card Number:
Expiry Date:
Payment Type:
Desired Transaction Day:
Payment Amount:
Email Address for E-Bill:

All information will be kept in full confidence.
Submitting new information will overwrite previous information on file
it will not cause double transactions.

Please Note:

  1. By completing this form and pressing SUBMIT you authorize the full amount payable to to be drawn by you on your financial institution on behalf of
  2. Your financial institution's treatment of each debit shall be the same as if you had personally directed the financial institution to pay as indicated and to charge the amount specified to your account.
  3. Pre-authorized payments will be drawn on Canadian dollar accounts only.
  4. You may apply to terminate this Auto-Credit Card Payment by contacting the office in writing.