Pre Authorized Debit Form Generator

A Pre Authorized Debit form is a legal form that outlines the payment terms between a payor and a payee. It is a requirement for collecting payments over Canada’s EFT network.

To collect payments directly from a customer’s bank account over the EFT network, you need permission from your customers. A properly formatted Pre Authorized Debit form is the way to gain this permission.

Authorization can be collected online as well as on paper (and even over the phone). There are specific requirements for online Pre Authorized Debit forms. Most businesses that facilitate Pre Authorized Debit payments online use a third-party payment provider like Rotessa.

Upon downloading your Pre Authorized Debit form, give the form to your customer to fill out. Once your customer has filled out all of the necessary fields this form can be used to automate payments over the EFT network. You can access the EFT network from your bank or a third party Pre Authorized Debit provider like Rotessa.

Yes. If a customer gives you notification that they want to cancel an authorization their request must be honoured. This is according to Payments Canada regulations.

A Pre Authorized Debit form requires the following elements:

1. Your contact information
2. Payor’s name
3. Payor’s bank branch transit number
4. Payor’s bank account number
5. Payor’s institution ID number
6. Amount and timing (for recurring and one-time payments)
7. Authorization statement
8. Cancelation details
9. Recourse statement
10. Date of agreement and signature (if a physical paper form)

This Pre Authorized Debit form template has all of these requirements.