Pre-Authorized Payments Form

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Set-Up Pre-Authorized Payments

This form is for pre-authorized payments from your bank account only and is not available for a line of credit.

You must upload a scanned copy, pdf or jpeg of your banking information (issued by your financial institution), clearly showing the account holder’s name and account details in order for this form entry to be valid.

The name(s) on the banking details provided must match the name(s) on the GrandBridge Energy account, otherwise the request to set up the plan will be denied.

If you have an overdue balance on your account and you’ve selected the paid in full plan, the balance owing at the time of the bill’s due date will be withdrawn in full.

If you select the Equal Payment Plan, it will be set up once the overdue balance is paid.

Pick Your Plan Type(Required)

''Paid in Full'' Plan (The full balance owing will be automatically withdrawn from your bank account on the due date).

''Equal Payment'' Plan (EPP)(This plan allows you to budget for an equal monthly payment, based on the last 365 days of billed usage, which is automatically deducted from your bank account on the withdraw date you select below. GrandBridge Energy will review and reconcile this payment plan regularly, to ensure the payment amount aligns with your actual usage. When/if you close your GrandBridge account, any amount owing on the final bill will be pre-authorized in full). *You must pay your full balance before selecting this plan*

Bank Change Only (This option is for existing pre-authorized payment plan customers who wish to provide new bank details. This change will take place on the next available due date).

Have you paid your current balance?(Required)

Yes

GrandBridge Energy cannot set up an equal payment plan if there is a balance owing. Please ensure your full balance is paid to select this plan.

If you selected Equalized Payments - Select your EPP Withdraw Date:(Required)

1st day of each month

15th day of each month

20th day of each month

GrandBridge Energy Account Details

Name(Required)

First Last

If Commercial, Name of Company

GrandBridge Account Number(s)(Required)

You can enter multiple account numbers if this form applies to multiple GrandBridge Energy accounts.

Primary Phone Number(Required)

Email Address(Required)

Financial Institution Details

Financial Institution Number(Required)

As shown on your bank form or void cheque

Financial Institution Branch Number(Required)

As shown on your bank form or void cheque. The Institution Branch Number is also referred to as the Transit Number.

Financial Institution Account Number(Required)

As shown on your bank form or void cheque

File(Required)

Accepted file types: pdf, jpg, jpeg, gif, png, tif, dwg, heif, Max. file size: 256 MB.

You must upload a copy of your banking details with this form.

Signature(Required)

Date(Required)

I authorize GrandBridge Energy to debit/credit my chequing account according to the plan I selected to pay my bill. This authorization is valid for all regular bills, as well as for reconciliation bills, credits due to me and final bills issued upon closure of my account. I understand that if my bank does not honour a payment, I must replace the payment (if applicable) and notify GrandBridge Energy to reactivate my payment plan.(Required)

Yes

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Pre-Authorized Debit Agreement

Set-Up Pre-Authorized Payments