CREDIT CARD & Payment INFORMATION

PAYMENT INFORMATION

Personal or PREC Banking Information - Must provide VOID cheque for account(s) - you can use up to two (2) accounts. If you use two (2) accounts, please indicate the percentage.

Account #1

Bank/Institution No

Transit No.

Account No.

CREDIT CARD INFORMATION

Name on Card:

Visa or Mastercard

Visa Mastercard

Card Number

Expiry Date

CVC Number

Code

I hereby authorize Realty Wealth Group Inc. to charge my (Visa/Mastercard) for the amount owed .

You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.payments.ca