Pre Authorized credit cards

Should you wish to make direct payments from your credit card. We accept two forms of credit cards

1. Master card

2. Vista

Credit card payments: Please complete only if you will be paying via Credit Card.

Mastercard                       Visa

Name (as it appears on Credit Card):
Credit Card#:
Expiry Date: _____________________________ Three digit Security code (on the back of the card): _____________________________________

I, as the account holder, authorize Fastcom and any other affiliated companies providing me with services and/or products and my financial institution to debit in accordance with the Rules of the Canadian Payments Association, my account at the branch specified above for the purpose of adding funds to my Fastcom account.  The information set out above may be sent to Fastcom’s bank and/or to your financial institution to implement this authorization.   Your account will be debited on your pre-established monthly billing date for the amount selected as per the Automatic Payment method above.  The amount of the debit may vary depending on the usage, the balance of the account and the payment plan selected.  In addition, the amount of the debit may be affected by the following items (1) credit or debit adjustments (2) fees for unreturned or damaged equipment provided to you on a rental basis. Administrative charges will apply for returned or declined payments.  This authorization is to remain in effect until Fastcom has received notification from me of its change or termination.  This written notification must be received at least 30 days before the next debit is scheduled.

I represent and warrant that the banking and account information provided above is complete and accurate and I will promptly notify Fastcom of any change in such information and all persons required to authorize withdrawals from the account specified above have authorized the debits to be drawn from the specified account pursuant to this authorization.


Signature: _________________________________________________

Date: _______________________________