PAD Agreement

Customer Information


Bank Account Information


Pre-Authorized Debit (PAD) Details

You, the Payor authorize UBSBC Inc, to debit the bank account identified above for the amount indicated above each time that the value of the services you have purchased, including applicable taxes, reaches that amount.
What are the services for?
These services are for (check one)
You, the Payor, may revoke your authorization at any time, subject to providing notice of 30 days. To obtain a sample cancellation form, or for more information on your right to cancel a PAD Agreement, contact your financial institution or visit

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
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