Eft Request Form Template – Canada

The Eft Request Form Template – Canada is provided in multiple formats, including PDF, Word, and Google Docs. These templates are both customizable and print-ready, ensuring they cater to your specific requirements effortlessly.

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Sample

Eft Request Form Template – Canada

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1. Requestor Information



2. Financial Institution Details



3. Account Information


4. Purpose of EFT Request

5. Start Date of EFT

6. Frequency of EFT Transactions

7. Authorization for EFT

8. Revocation of EFT Authorization

9. Signatures



PDF

WORD

Examples

EFT Request Form Template – Canada (1)
Form Title:
Electronic Funds Transfer (EFT) Request Form
Applicant Information:
[Applicant’s Name]
[Applicant’s Address]
[City, Province, Postal Code]
[Applicant’s Phone]
[Applicant’s Email]
Bank Details:
Bank Name: [Bank Name]
Account Holder: [Account Holder’s Name]
Account Number: [Account Number]
Transit Number: [Transit Number]
Institution Number: [Institution Number]
Type of Transfer:
[ ] One-time transfer
[ ] Recurring transfers (every [Specify Period])
Amount:
C$ [Amount] (amount to be transferred)
Start Date:
[Start Date] (for recurring transfers)
Authorization:
I hereby authorize [Business/Organization Name] to process EFT transactions from my account as outlined in this request form.
I understand that it is my responsibility to notify [Business/Organization Name] regarding any changes to my banking information.
Signature:
[Signature]
[Date]
EFT Request Form Template – Canada (2)
Form Title:
Electronic Funds Transfer (EFT) Request Form
Applicant Information:
[Full Name]
[Address Line 1]
[Address Line 2 (if any)]
[City, Province, Postal Code]
[Phone Number]
[Email Address]
Bank Information:
Bank Name: [Your Bank Name]
Account Name: [Account Holder’s Name]
Account Number: [Account Number Breakdown]
Routing/Transit Number: [Routing Number]
Transfer Details:
Payment Type: [ ] Salary Payment
[ ] Reimbursement
[ ] Dividend Payment
[ ] Other: [Specify]
Payment Amount:
C$ [Total Amount] to be transferred
Payment Frequency:
[ ] One-time
[ ] Weekly
[ ] Monthly
[ ] Annually
Starting On:
[Effective Date] (if applicable)
Authorization Statement:
I authorize [Company’s Name] to withdraw funds from my bank account as stated in this request. I will provide notice of any changes promptly and have the right to revoke this authorization by contacting [Company’s Contact Information].
Signature:
[Signature]
[Date Signed]

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Eft Request Form Template - Canada