Complete your Membership Agreement.

Please Provide your Personal Information

First Name
Last Name
Address Line 1
Address Line 2
City
Province / Territory
Postal Code
Phone
Email
Which Agent Helped You Today?
Air Miles Code
Promo Code

Please select which a Membership Option

(The red highlighted box represents which package you have selected)

Would you like any of our other services?

(The red highlighted box represents which package you have selected)

Here is a Review of Your Order

Your Order
Setup Cost
Reoccuring Cost
Membership
$
$
Sub-Total:
$
$
GST:
$
$
Total:
$
$

How are you paying your setup fee?

Which institution or bank are you sending your E-transfer from?

IMPORTANT: Once Complete, you will still be required to complete this application.

Please Send E-transfer to: emt@creditcanada.net

ATB Financial Bank of Montreal CIBC Dejardins manulife national President's Choice RBC Scotiabank TD Canada Trust

**Your institution will open in new window.**

Setup Amount Due:

Confirmation Number:

Please Fill in The Following Form to Complete Your Pre-Authorized Debit Agreement

Because you have selected Premium Membership Option A, we do require a Pre Authorized Debit agreement to automatically withdrawal your monthly payments.

Cheque
Account Holder Name
Transit Number
Institution Number
Account Number
Account Type

Monthly Amount to be Withdrawn:

Date to Debit Account

PAYMENT OF SCHEDULED MEMBERSHIP PAYMENTS, SET UP FEES AND ACCOUNT PAYMENTS, PLUS APPLICABLE CHARGES & FEES IF REQUIRED.

Statement with regard to Pre-notification

I/We authorize Canada Credit Fix Inc. (CCF), and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one time payments from time to time, payments of all charges arising under my/our Canada Credit Fix Inc membership or payment account(s). Canada Credit Fix Inc. will obtain my/our authorization for any other one-time sporadic debits. This Authority is to remain in effect until Canada Credit Fix Inc. has received written notification from me/us of its change or termination. This notification must be received at least thirty (30) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD agreement at my/our financial institution or by visiting www.cdnpay.ca. Canada Credit Fix Inc. may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least ten (10) days prior written notice to me/us. I/We have certain recourse rights if any debit does not comply with this agreement. I/We have the right to receive reimbursement for any PAD that is not authorized or is not consistent with the PAD Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution or visit www.cdnpay.ca. In the event that the amount of this PAD changes, we will send you a written notice, by email, identifying the new amount at least 10 days before the first PAD for that amount, with the exception of a reduction in the amount due to a change in tax rate. I/We authorize CCF to debit a $40.00 NSF fee for returned Authorized Debits.

I/We authorize CCF to debit a $40.00 NSF fee for returned Authorized Debits.

*No monies collected by CCF are refundable.

I/We understand and accept the terms of participating in this PAD plan and have full signing authority to the aforementioned account.

Please Fill in The Following Form to Complete Your Pre-Authorized Debit Agreement

Because you have selected Premium Membership Option A, we do require a Pre Authorized Debit agreement to automatically withdrawal your monthly payments and your Setup Fee.

Cheque
Account Holder Name
Transit Number
Institution Number
Account Number
Account Type

Setup Amount Due:

Date to withdrawal Setup Fee

Monthly Amount to be Withdrawn:

Date to Your Payments

PAYMENT OF SCHEDULED MEMBERSHIP PAYMENTS, SET UP FEES AND ACCOUNT PAYMENTS, PLUS APPLICABLE CHARGES & FEES IF REQUIRED.

Statement with regard to Pre-notification

I/We authorize Canada Credit Fix Inc. (CCF), and the financial institution designated (or any other financial institution I/We may authorize at any time) to begin deductions as per my/our instructions for monthly regular recurring payments and/or one time payments from time to time, payments of all charges arising under my/our Canada Credit Fix Inc membership or payment account(s). Canada Credit Fix Inc. will obtain my/our authorization for any other one-time sporadic debits. This Authority is to remain in effect until Canada Credit Fix Inc. has received written notification from me/us of its change or termination. This notification must be received at least thirty (30) business days before the next debit is scheduled at the address provided below. I/We may obtain a sample cancellation form, or more information on my/our right to cancel a PAD agreement at my/our financial institution or by visiting www.cdnpay.ca. Canada Credit Fix Inc. may not assign this authorization, whether directly or indirectly, by operation of law, change of control or otherwise, without providing at least ten (10) days prior written notice to me/us. I/We have certain recourse rights if any debit does not comply with this agreement. I/We have the right to receive reimbursement for any PAD that is not authorized or is not consistent with the PAD Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I/We may contact my/our financial institution or visit www.cdnpay.ca. In the event that the amount of this PAD changes, we will send you a written notice, by email, identifying the new amount at least 10 days before the first PAD for that amount, with the exception of a reduction in the amount due to a change in tax rate. I/We authorize CCF to debit a $40.00 NSF fee for returned Authorized Debits.

I/We authorize CCF to debit a $40.00 NSF fee for returned Authorized Debits.

*No monies collected by CCF are refundable.

I/We understand and accept the terms of participating in this PAD plan and have full signing authority to the aforementioned account.

Here is a Review of Your Order

Your Order
Setup Cost
Reoccuring Cost
Membership
$
$
Sub-Total:
$
$
GST:
$
$
Total:
$
$
Personal Information

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

Province or Territory:

Phone:

Email:

Agent:

Airmiles:

Coupon Code:

Membership Type:

Setup Information:

Setup Payment Type:

Setup Debit Date:

EMT Confirmation Number:

Reoccuring Payment Information:

Date to Debit Account:

Banking Information:

Account Holder Name:

Branch Number:

Institution Number:

Account Number:

Account Type:

Additional Notes

Please Sign Your Signature In The Box Below to Complete Your Application

By signing above and pressing submit I understand that My signature will be applied to the membership agreement. By signing above I agree to all the terms, conditions and limitations and acknowledge and understand the contents of the membership agreement. You will automatically receive a copy of your signed agreement within minutes. Please insure that your email address is correct. In the event that you do not receive a copy of the agreement in your email please contact your credit specialist or call us toll free 1-855-530-3646 or email us at info@CanadaCreditFix.com Before signing above please read the membership agreement.

I/We understand and accept the Canada Credit Fix Disclosure For All Member and have full signing authority to the aforementioned account.

I/We understand and accept the Canada Credit Fix General Terms and Conditions and have full signing authority to the aforementioned account.