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Pre-authorized Payment Form

Thank you, your form has been submitted. We will review your details and may contact you if we require additional information.

We are currently experiencing a 3 to 4 business day turnaround time for processing forms.

Service Address

If this form is completed before your first invoice, you will not have a customer number.
We're sorry, but your address could not be located in our database. Please check your input for any errors. Click here for an example of how an address should be entered. If you believe your address is correct, please click here to get in touch with our customer support department
Account Information
Pre-authorized Payments

With Pre-Authorized Chequing from Provident Energy Management Inc., your Bill is automatically paid from your chequing account. You will continue to receive a regular invoice and we simply deduct the amount owing on the due date of the invoice. Once set up on Pre-Authorized Chequing your invoice will state “Pre-Authorized Payment Plan Do Not Pay”.

Please note the following to ensure proper set up:

  • include a “voided” cheque, or fill out the form below
  • Any outstanding amounts must be paid in full before the pre-authorized payment plan can be applied to your account

Fill in ALL sections to ensure proper set up on Pre-Authorized Payment Plan. Click here to view a sample of a void cheque.

Please note if a payment is dishonored by your bank for any reason, we have the right to terminate your participation in the Plan. A service fee will be applied to your account in response to the dishonored payment.

Upon termination, ANY AMOUNT DUE shall be paid directly to Provident Energy Management Inc. Cancellation of pre-authorized debit does not constitute cancellation of service by Provident Energy Management Inc. and the customer shall be liable for any past, present or future amounts owing.

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 pre-authorized debit agreement. To obtain more information on your recourse rights, contact your financial institution or visit www.cdnpay.ca